Urine Culture Results Research Articles

Bacterial and Antibiogram Profile of Urinary Tract Infection Patients in Tertiary Hospital, Surabaya, Indonesia

Highlights: Most urinary tract infections are caused by Gram-negative bacteria with E. coli being the most common bacteria. Antibiotics with the highest susceptibility for Gram-negative bacteria were ertapenem, meropenem, amikacin, and imipenem. Antibiotics with the highest susceptibility for Gram-positive bacteria mainly were susceptible to chloramphenicol,streptomycin, vancomycin, rifampin, tigecycline, teicoplanin, and ampicillin. Abstract: Urinary tract infection (UTI) is one of the most common bacterial infections. Inappropriate antibiotic use for UTI treatment may lead to antibiotic resistance. This study aimed to provide an updated bacterial and antibiogram profile from urine specimens of patients diagnosed with UTI. This study was a retrospective study using urine culture and antibiotic susceptibility test results obtained from Clinical Microbiology Laboratory in a tertiary general hospital in Surabaya, Indonesia for a two-month period patients. Most aged more than and/or equal to 59 years, in both sexes. Gram-negative bacteria, particularly , was being the most between June to July 2019. There were 215 patients with significant urine culture results of 54.4% from Escherichia coli female bacteria were carbapenem antibiotics and amikacin, while teicoplanin and vancomycin were some antibiotics susceptible to gramcommon bacteria that caused UTI, followed by K. pneumoniae. Some antibiotics with the highest susceptibility to gram-negative positive bacteria. This study result indicated that there was an urge to conduct local antibiogram profile investigation due to the low susceptibilities shown in recent empirical therapy recommendations, such as trimethoprim sulfamethoxazole, fluoroquinolone, nitrofurantoin, and fosfomycin.

Pediatric kidney transplant recipients with and without underlying structural kidney disease have a comparable risk of hospitalization associated with urinary tract infections

IntroductionUrinary tract infections (UTIs) are a common and potentially serious kidney transplant complication. Pediatric kidney transplants are potentially at increased risk for UTIs when structural kidney disease is the underlying end-stage kidney disease (ESKD) etiology. The objective of this manuscript is to determine if children with structural kidney disorders are more prone to UTIs post kidney transplant.Materials and methodsHospitalizations for pediatric kidney transplant recipients were retrospectively reviewed over a 4-year period for UTIs in the diagnostic codes. The patient’s age, sex, graft age, underlying diagnosis for cause of ESKD, symptoms at presentation, urinalysis results, and urine culture results were recorded. UTI rates, febrile UTI rates, and UTI rates in the 1st year post-transplant were compared between children with ESKD due to structural vs. non-structural kidney disease.ResultsOverall, 62 of 145 pediatric patients with kidney transplants accounted for 182 hospitalizations for kidney transplant complications over the 4-year study period. UTIs were components of 34% of the hospitalizations. Overall, UTI rates, febrile UTI rates, and UTI rates for the 1st year post kidney transplant were comparable for children with vs. without structural ESKD etiologies.ConclusionUrinary tract infections are frequent components of hospitalizations for pediatric kidney transplant recipients. Children with and without structural kidney disease as an ESKD etiology have similar UTI rates indicating that UTI susceptibility is primarily due to the transplant process and/or medication regimens. UTIs represent a potentially modifiable risk factor for pediatric kidney transplant complications.

Leukocyte Esterase and Nitrite Urine Reagent Strip Utility Under Altered Assay Conditions in Dogs.

The study evaluated leukocyte esterase (LE) and nitrite reagent pad usefulness in canine urine using multiple time endpoints and decision thresholds. Whole and sedimented urine samples from 116 client-owned dogs were analyzed with reagent strips from four manufacturers. Results for LE and nitrite were recorded every 30 s up to 150 s using "trace" and "+" positive thresholds and compared to microscopic urine sediment analysis and culture results. Sedimented urine assessed at 150 s with a "trace" positive threshold for LE had significantly or trending higher sensitivity (brand dependent) for pyuria detection compared with manufacturer recommendations. Using these parameters, LE sensitivity and negative likelihood ratio were 66.67-89.47%, and 0.13-0.37, respectively. Following manufacturer recommendations, LE specificity and positive likelihood ratio were 96.91-100% and 17.02-30.63, respectively. Nitrite performance for pyuria and bacteriuria detection was poor for all conditions. LE reagent pads are a useful screening test for pyuria detection using sedimented urine and a "trace" positive threshold at 150 s, whereas LE use with traditional manufacturer recommendations is a good confirmatory test for pyuria detection. Nitrite reagent pads are not useful for pyuria or bacteriuria detection.

Nephrolithiasis management and outcomes in pediatric patients with limited mobility

Pediatric patients with limited lower extremity mobility may be at increased risk of developing nephrolithiasis due to bone mineral metabolic derangements. This study sought to assess whether nephrolithiasis management and related outcomes differ between ambulatory versus non-ambulatory pediatric patients. This was a retrospective review of ambulatory and non-ambulatory pediatric patients with nephrolithiasis from 2010 to 2021 from a single tertiary care center. Demographics, surgical history, stone compositions, and 24-h urine data were reviewed. Adjusted logistic and linear regression models were utilized to assess whether mobility status was associated with nephrolithiasis-related management and outcomes, including: age at first stone; requiring surgical intervention for stones; number of surgeries; stone compositions; urine culture results; and completion of 24-h urine studies. Among 339 pediatric patients with nephrolithiasis, 67 (19.8%) were non-ambulatory. In adjusted analyses, non-ambulatory patients had 3.24 times greater odds of requiring surgical intervention for stones (95% CI: 1.93-6.84; p<0.0001); among those who required surgery, non-ambulatory patients required an average of 0.82 more surgical interventions (95% CI: 0.35-1.30; p=0.0008) than ambulatory patients. Additionally, non-ambulatory patients had 5.28 times greater odds of having a positive urine culture at the time of surgery (95% CI: 2.35-14.08; p=0.0001) and were significantly less likely to undergo 24-h urine studies (OR: 0.35; 95% CI: 0.15-0.83; p=0.02). Stone composition significantly varied by mobility status, with non-ambulatory patients being significantly more likely to form calcium apatite (OR: 5.1; 95% CI: 2.18-11.93; p=0.0002) or struvite (OR 3.72; 95% CI: 1.18-11.74; p=0.03) stones, and significantly less likely to form calcium oxalate stones (OR: 0.19; 95 CI: 0.08-0.47; p=0.0003). Among all patients, age at first stone occurred at a median age of 13.4 years (IQR: 8.2-16.4) and did not significantly differ by mobility status (p=0.92). Patients with limited mobility required surgery for nephrolithiasis at significantly higher rates and had different stone compositions than ambulatory patients. Obtaining a 24-h urine study in patients with comorbidities affecting ambulation was uncommon, compared to ambulatory patients. Similarly to ambulatory patients, pediatric patients with limited mobility who develop nephrolithiasis tend to first present with stones in early adolescence.

Innovative medical technologies for the treatment of urinary tract infections in peri- and postmenopausal women

Objectives: to evaluate the effectiveness of Utipro Plus AF for uncomplicated urinary tract infections in women in the peri- and postmenopausal period.Materials and methods. The study included 45 patients aged 48–70 years with verified uncomplicated urinary tract infection. All patients received antimicrobial agents in accordance with approved guidelines. 25 women (main group) also received Utipro Plus AF, 20 women (control group) received only antimicrobial agents. The effectiveness of treatment was assessed on the 6th, 11th, 30th and 75th day of observation. Efficiency criteria were a decrease in the intensity of clinical symptoms, a decrease in the number of relapses, and bacterial sanitation based on the results of urine cultures (≤ 103 CFU/ml). Results. Clinical picture changed dramatically in the patients of the examined groups after treatment. Main group had no urinary incontinence, imperative urges to urinate, the frequency of dysuria disorders decreased by three times in this group, pain in the lower abdomen and burning sensation during urination were 5 times less common. Recurrences of urinary tract infections were noted in both groups by bacteriological and symptomatic criteria, but their frequency was much lower in the group that received Utipro Plus AF in addition to antibiotics. The number of positive results of urine cultures on the 75th day of observation decreased to 16% in the main group, and to 65% in the control group. Recurrences of urinary tract infections according to clinical criteria on the 75th day of observation were verified in 3 patients of the main group and in 12 patients in the control group. Conclusions. The medical product Utipro Plus AF effectively reduces bacteriological and clinical signs of uncomplicated urinary tract infections, which makes its use advisable as an additional agent to antibiotic therapy in women with uncomplicated urinary tract infections in peri- and postmenopausal period.

Predicting urine culture results in candidates for lithotripsy.

Urological guidelines assert that "urine culture should be obtained" before surgical management of ureteral or kidney stones. Thus, many surgeries are delayed by 1-3 days until the results of urine culture are available. During this time, the patient frequently experience pain and possible kidney damage. We investigated the hypothesis that it is possible to predict the results of urine culture in candidates for surgical intervention using parameters that are accessible immediately upon admission. A database of 1000 patients who underwent either percutaneous nephrolithotomy (PCNL) or ureteroscopy/retrograde intrarenal surgery was analyzed. Eleven parameters potentially related to urinary infections and accessible to the clinician at the emergency department were correlated with the preoperative urine culture results. Of the patients, 234 (23.4 %) had positive cultures. On multivariate analysis, only sex, hydronephrosis grade, and history of previous nephrolithotomy were significantly associated with a positive preoperative urine culture. The risk of a positive culture can be easily determined from a simple table or an Excel-based calculator. This risk could be as low as 0.45% for a man without a history of PCNL and no hydronephrosis (4% in a woman with similar parameters) or as high as 79.5% in a man with a history of PCNL and hydronephrosis (85% in a woman with similar parameters). The risk of preoperative positive urine culture can be predicted using 3 parameters that are accessible upon admission. In low-risk cases, prompt surgical treatment can be provided, eliminating the anticipation time for urine culture results.

Risk factors for thedevelopment of acute pyelonephritis in women with a positive urine culture.

In treating lower urinary tract symptoms (LUTS), the risk of overtreatment with antibiotics must be reconciled with the risk of an untreated urinary tract infection (UTI) progressing to acute pyelonephritis (APN). Using Cerner HealthFacts, a longitudinal clinical informatics database, we aimed to determine risk factors associated with the development of APN from UTI in an effort to guide the initiation of empiric antibiotics. We queried the Cerner HealthFacts database for women over age 18 with a positive urine culture. Any patient with an International Classification of Disease (ICD) code indicating chronic pyelonephritis was excluded. Development of APN within 30 days of the positive culture, specified by ICD coding, was our primary outcome. Patient and facility factors were assessed as potential risk factors for the development of APN using multivariable regression. Out of 58 344 women with a positive urine culture, 3.9% (2296) developed APN. Mean patient age was 54.4 ± 25.3 years. Overall, 12 variables were predictive for APN and 11 variables were protective against APN. Presence of obstructive and reflux uropathies (OR 4.58), presentation to an acute care facility (OR 3.19), urinary retention (OR 2.30), history of UTI (OR 2.19), and renal comorbidities (OR 2.07) conferred the highest odds of APN development. The most protective variable against APN development was cognitive impairment (OR 0.49). Identified risk factors associated with APN development may aid decisions regarding empiric antibiotic initiation for patients presenting with LUTS while awaiting urine culture results. The relationship between cognitive impairment and progression to APN deserves further study.

Urine bacterial culture growth and association with urine sedimentation and clinical findings in cats with acute kidney injury.

A urine culture is often pursued in cats with acute kidney injury (AKI) to screen for bacterial growth in the urine, but it can be cost prohibitive. The aim of the study was to determine the ability of a urinalysis and lower urinary tract signs (LUTS) to predict urine culture results in cats with AKI. Ninety-seven cats with AKI were included in this study. This was a retrospective, observational study. Medical records from 2008 to 2018 were reviewed to identify cats with AKI that had a paired urinalysis and urine bacterial culture. The sensitivity, specificity, positive predictive value and negative predictive values of microscopic bacteriuria, pyuria, hematuria and the presence of LUTS for predicting urine culture results was calculated. Thirty-two percent of cats (n = 31) had a positive urine culture. Of these, 28 (90%) had bacteriuria, 21 (68%) had pyuria, 13 (42%) had hematuria and 10 (32%) had LUTS. Of the 42 cats without hematuria or pyuria, seven had a positive urine culture (17%). Bacteriuria had a high sensitivity (90%) and specificity (92%) for predicting urine culture bacterial growth. The absence of bacteriuria had a high negative predictive value for no bacterial growth (95%). The odds of a positive urine culture were increased with bacteriuria (odds ratio [OR] 114, 95% confidence interval [CI] 29-621; P <0.001), pyuria (OR 21, 95% CI 7-70; P <0.001) and LUTS (OR 5, 95% CI 1.7-16; P = 0.004). Hematuria was not associated with a positive culture (sensitivity 42%, specificity 52%). Microscopic bacteriuria and pyuria on urine sediment evaluation and LUTS can be helpful for predicting bacterial culture results in cats with AKI and in settings where submitting a urine culture may not be financially feasible.

Can diagnostic and imaging recommendations from the 2011 AAP UTI guidelines be applied to infants

In 2011, the American Academy of Pediatrics (AAP) published guidelines regarding diagnosis and management of children 2-to-24-months-old with initial febrile urinary tract infection (fUTI). Available data were insufficient to determine whether evidence from studies of 2-to-24-month-olds applies to those <2-months-old, so they were excluded. This study aimed to 1) compare demographic, clinical, imaging and outcomes between patients <2-months-old and those 2-to-24-months-old hospitalizedwith fUTI, and 2) assess whether diagnostic and imaging recommendations of the AAP 2011 guidelines apply to those <2-months-old. A cohort study of patients ≤24-months-old hospitalized at a children's hospital with fUTI from 2016 to 2018 was conducted. Data were collected via a prospectively generated electronic medical record note template, supplemented with retrospective chart review. Primary outcomes included differences in demographics, clinical presentation, urine culture results, and imaging utilization/results by age group. Secondary outcomes included surgical procedures, UTI recurrence, and 90-day all-cause readmissions and emergency department (ED) revisits. Univariate and bivariate statistics were utilized to compare age groups. Overall, 137 patients were included (median age 70 days, 55.5% male [92.1% uncircumcised], 53.3% Hispanic/Latino, 89.8% 1st fUTI). There were no demographic differences between groups, except children <2-months-old were more frequently male (71.2 vs 43.6%, p=0.002). The Summary Table compares clinical factors and imaging utilization byage. There were no differences in urinalysis or urine culture results between groups. Patients <2-months-old had shorter fever duration, lower maximum temperature, and lower white blood cell counts. Voiding cystourethrograms (VCUGs) were recommended and obtained more frequently in patients <2-months-old, but there were no differences in renal and bladder ultrasound (RBUS) or VCUG results between age groups. There were no differences in UTI recurrence (13.6% of <2-months-old vs 14.1% of 2-to-24-months-old, p=1.00) or fUTI recurrence (13.6 vs 7.7%, p=0.40) within 1 year, 90-day readmission (6.8 vs 6.4%, p=1.00), or 90-day ED revisit (22.0 vs 20.5%, p=1.00). There were minimal differences between the <2-months-old and 2-to-24-months-old age groups in demographics, laboratory (including microbial) or imaging results, or clinical outcomes. Patients <2-months-old were more frequently male and less ill. These data support applying urinalysis and urine culture diagnostic criteria, and universal RBUS, from the AAP guidelines to patients <2-months-old. Given utilization differences, applicability of VCUG guideline recommendations requires further clarification for patients <2-months-old. Laboratory testing and RBUS recommendations from the AAP guidelines may be safely applied to infants <2-months-old. Further studies are needed to clarify optimal VCUG recommendations.

Prevalence and treatment tactics of nonspecific urinary tract infection in tuberculosis patients

The objective: to study prevalence and evaluate the efficacy of therapy and prevention of nonspecific urinary tract infection (NUTI) in tuberculosis patients as well as the possibility of combining them with anti-tuberculosis therapy.Subjects and Methods. 936 patients with various localizations of tuberculosis at the age from 18 to 96 years old were examined. Men made 447 (47.8%), and women – 489 (52.2%). NUTI was diagnosed based on the following criteria: the presence of typical symptoms, leukocyturia and bacteriuria detected by urine microscopy, positive results of urine culture for nonspecific bacterial population, and negative urine tests for tuberculous mycobacteria.Results. The prevalence of NUTI among tuberculosis patients made 174 (18.6%) out of 936 patients, it was found among all forms of TB but most frequently in urogenital tuberculosis (74.1%). Prophylactic treatment tactic (antibacterial therapy and the herbal formulation of Kanefron N) was offered. Treatment efficacy made 94.6%, while patients received anti-tuberculosis therapy, and the combination of drugs caused no adverse reaction in any patient. When choosing a therapeutic tactic, it is necessary to take into account the presence of structural and functional changes in the urinary tract which reduce treatment efficacy.

Urological outcomes in children with congenital Zika syndrome: The experience of a cohort in Campina Grande, Brazil.

To describe the urological outcomes in children with congenital Zika syndrome (CZS) and investigate the relationship between clinical and urological findings in this population. This cross-sectional study involved children with CZS followed up by a referral centre for children with microcephaly in the state of Paraiba in northeast Brazil. The urological evaluation included clinical history, urine culture results, ultrasonography of the urinary tract, and urodynamic evaluation, following the protocol proposed by Costa Monteiro et al. (2017). Descriptive statistical analysis was performed in addition to association and correlation tests, considering clinical and urodynamic variables. Among the 88 children with CZS (35.5 ± 5.5months), 97.7% had microcephaly, and 51% presented urinary tract infection (UTI) confirmed with clinical history and lab tests. The number of confirmed UTI episodes varied from one to 14 per child. The urodynamic evaluation confirmed the presence of an overactive bladder in 78 children and incomplete voiding in 50. Urodynamic findings were associated with the number of confirmed UTI episodes, child's sex, and actual weight, in addition to the use of anticonvulsant and myorelaxant drugs. UTIs were confirmed in most children. Other urological outcomes observed were overactive bladder and low bladder capacity, which were associated with the number of confirmed UTI episodes, use of anticonvulsants and myorelaxants, and the child's sex and weight. These are treatable conditions, and it is paramount that paediatricians, neonatologists, and infectious disease specialists are aware of them to make clinical decisions and help reduce the risk of renal damage and other morbidities.

To Determine the Efficacy of Antibiotic Prophylaxis in patients Undergoing Flexible Cystoscopy

Background: Flexible cystoscopy is a commonly performed intervention in urology practice. It has both diagnostic and therapeutic value and has an added advantage of being used as an outpatient procedure. However one of the common complication associated with it, is the development of Urinary tract infection (UTI) because of its minimally invasive nature. Aim: To determine the efficacy of antibiotic prophylaxis in patients undergoing flexible cystoscopy. Methods: A randomized control study was performed in total 144 patients selected for flexible cystoscopy. Patients were divided into Group A (Antibiotic group) and Control Group B. Group A received a single dose of Levofloxacin 500mg one hour before procedure, while no antibiotic prophylaxis was given to Group B. Primary outcome was development of UTI, which was assessed by subjective symptoms of UTI, results of urine culture and routine urine examination at 1st week after the procedure Results: After 1 week of procedure, 5 patients (6.9%) in Group A and 7 patients (9.7%) in Group B developed UTI. 3 patients (4.1%) in Group A and 6 patients (8.3%) in Group B developed asymptomatic bacteriuria after 1 week. 64 patients (88.9%) in Group A and 59 patients (81.9%) in Group B did not develop UTI after 1 week of procedure Conclusion: Prophylactic use of antibiotics before flexible cystoscopy has no effect in reducing the frequency of post procedure urinary tract infections Keywords: Urinary Tract Infection UTI), Cystoscopy, Antibiotic prophylaxis

Guideline-Based Risk Stratification for Febrile Young Infants Without Procalcitonin Measurement.

Guideline-Based Risk Stratification for Febrile Young Infants Without Procalcitonin Measurement.

MO347: When Aki is Not Due to Rhabdomyolysis: A Rare Case of Nsaid-Related Rhabdomyolysis

Abstract BACKGROUND AND AIMS Non-steroidal anti-inflammatory drugs (NSAIDS) have well-understood side effects. Rhabdomyolysis, though, is a rare adverse effect of NSAIDs and only a few cases have been reported. Here, we report a case of NSAID-related acute kidney injury (AKI) in an old diabetic woman who was found to have high muscle enzymes. METHOD A 75-year-old diabetic woman was referred to a nephrology clinic due to nausea, vomiting and high serum creatinine. She was a known case of type 2 diabetes that was well controlled by oral hypoglycemic agents (metformin, gliclazide and linagliptin). The patient was not known to have documented hypertension. She had never visited a nephrologist but her baseline creatinine was 1.2 mg/dL. Her family also admitted that she has frequently used different NSAIDs (celecoxib, diclofenac and ibuprofen) due to knee pain in the past few weeks. The patient had developed lower extremity weakness 3 days before referral followed by nausea and vomiting, 2 days later. Physical examination showed mild pitting edema of both feet. Her new data were as followings: Blood urea nitrogen: 85 mg/dL, creatinine: 7.5 mg/dL, uric acid: 4.5 mg/dL, sodium: 135 meq/L, potassium: 4.7 meq/L, hemoglobin 11.3 g/dL, white blood cells 5400 U/micL, platelets 186 000 U/micL, creatinine phosphokinase (CPK): 12730 U/L, lactate dehydrogenase (LDH) 1344 U/L, alanine transaminase (ALT) 78 U/L and aspartate transaminase (AST) 203 U/L. Urinalysis showed specific gravity 1.020, protein 4+, sugar 1+, blood trace, red blood cells (RBC) 2–4/hpf, white blood cells (WBC) 4–6 per hpf, and also, 2–4 granular casts per hpf were reported. Urine culture result was negative. 24-h urine specimen showed proteinuria of 7300 mg. Renal ultrasound showed normal-sized kidneys with increased corticomedullary differentiation and bilateral simple cortical cysts. Renal cortical thickness was &amp;gt;1 cm bilaterally, and there was no hydronephrosis or other pathologies. Hemodialysis was started for the patient and she underwent a kidney biopsy to define the cause of acute kidney injury (AKI). RESULTS Renal biopsy showed: membranous glomerulonephritis stage 2/4, severe acute tubulointerstitial nephritis, focal global glomerulosclerosis and vascular thickening. Interstitial fibrosis and tubular atrophy (IFTA) were reported to be about 20%. There was no sign of acute tubular necrosis. (pictures). Immunofluorescent (IF) study showed a 1+ granular pattern deposition of IgG along the glomerular basement membrane. CONCLUSION NSAID-related rhabdomyolysis is a rare side effect of this class of analgesics. Although any agent from this class can be causative, most reports involve the most widely used ones: diclofenac and Ibuprofen. AKI in the presented patient could have different etiologies regarding data and medical history. The value of renal biopsy is well depicted in this case. Although rhabdomyolysis seemed to be the principal etiology, at the first sight, NSAID-related interstitial nephritis played the main role in AKI. The patient was put on hemodialysis for 2 weeks. Any forms of NSAIDs were withheld. Acceptable renal recovery was achieved in 3 weeks; the patient was free from dialysis. Two months later, she has creatinine of 1.2 mg/dL and normal CPK and LDH levels. Angiotensin receptor blocker (ARB) was started as the beginning treatment of membranous nephropathy. Renal biopsy is of great value to differentiate causes of non-typical cases of AKI especially in rare cases where laboratory data may be confusing or misleading.

PD19-07 ARE PATIENTS STENTED FOR SEPTIC URETERAL STONES MORE LIKELY TO EXPERIENCE INFECTIOUS COMPLICATIONS AT TIME OF DEFINITIVE MANAGEMENT THAN THOSE STENTED FOR NON-INFECTIOUS INDICATIONS?

You have accessJournal of UrologyCME1 May 2022PD19-07 ARE PATIENTS STENTED FOR SEPTIC URETERAL STONES MORE LIKELY TO EXPERIENCE INFECTIOUS COMPLICATIONS AT TIME OF DEFINITIVE MANAGEMENT THAN THOSE STENTED FOR NON-INFECTIOUS INDICATIONS? Ginnie Jeng, and Simon J. Hall Ginnie JengGinnie Jeng More articles by this author , and Simon J. HallSimon J. Hall More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002557.07AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Current practices for septic ureteral stones include urgent decompression of the collecting system and antibiotic administration. Surgical management of the stone is delayed until infection has resolved. Therefore, the purpose of this study is to evaluate the rate of urosepsis after stenting, identify risk factors for developing urosepsis, and define optimal antibiotic prophylaxis for ureteroscopy (URS). METHODS: We conducted a retrospective cohort study of patients who underwent urgent ureteral stenting followed by URS with laser lithotripsy for urolithiasis management from January 2018 to December 2019 at Northwell Health. Data collected include patient demographics, stent indications, stone characteristics, blood and urine culture results, and antibiotics used. Statistical analyses include Pearson’s Chi Square analysis and Fisher’s Exact test, with p values <0.05 considered statistically significant. RESULTS: 181 patients were included in this study, with 88 stented for urosepsis concerns (Sepsis Group, SG) and 92 for intractable pain or acute kidney injury (Non-Sepsis Group, NSG). SG is significantly more likely to have a positive culture check (SG=20.5%, NSG=6.5%, p=0.003). However, there is no significant difference in the rate of urosepsis between stenting and URS (SG=5.7%, NSG=4.3%, p=0.681) or after URS (SG=5.7%, NSG=2.2%, p=0.224). The antibiotic prophylaxis strategy for URS (pretreated, standard, targeted) also does not impact urosepsis rates after URS (p=0.501). Urosepsis in SG is more severe, however, with 40% of SG requiring ICU stay (NSG=16.7%) and 1 death in SG from urosepsis after URS. The only significant risk factors for developing urosepsis or positive culture check are atherosclerosis (p=0.012), right sided stents (p=0.014), and prolonged length of stay (p<0.001) (Table 1). CONCLUSIONS: Despite sterile ureteral stenting and adequate antibiotic prophylaxis, a significant portion of patients still develop urosepsis or positive culture checks. Surprisingly, this also applies to patients who were initially stented for non-infectious indications. Given the morbidity and mortality of urosepsis, further research to decrease urosepsis rates following URS is needed. Source of Funding: None © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e351 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Ginnie Jeng More articles by this author Simon J. Hall More articles by this author Expand All Advertisement PDF DownloadLoading ...

Pyeloplasty with ureteral stent placement in children: Do prophylactic antibiotics serve a purpose?

Ureteral stents are commonly used during pyeloplasty to ensure drainage and anastomotic healing. Antibiotic prophylaxis is often used due to concerns for urinary tract infection (UTI). Although many surgeons prescribe prophylactic antibiotics following pyeloplasty, practices vary widely due to lack of clear evidence-based guidelines. We hypothesize that the rate of stent UTI does not significantly vary between children who receive antibiotics and those who do not. We reviewed the medical records of 741 patients undergoing pyeloplasty between January 2010 and July 2018 across seven institutions. Exclusion criteria were: age older than 22 years, no stent placed, externalized stents used, and incomplete records. Surgical approach, age, antibiotic use, stent duration, Foley duration, and urine culture results were recorded. Patients were categorized into two groups, those younger than four years of age and those four years and older as proxy for likely diaper use. Univariate logistic regression was conducted to identify variables associated with UTI. Multivariable backward stepwise logistic regression was used to identify the best model with Akaike information criterion as model selection criteria. The selected model was used to calculate odds ratios and 95% confidence intervals summarizing the association between prophylactic antibiotics and stent UTI while controlling for age, gender, and intra-operative urine cultures. 672 patients were included; 338 received antibiotic prophylaxis and 334 did not. These groups differed in mean age (3.91 vs. 6.91 years, P<.001), mean stent duration (38.5 vs. 35.32 days, P<.001), and surgical approach (53.25% vs. 32.04% open vs. laparoscopic, P<.001). The incidence of stent UTI was low overall (7.59%) and similar in both groups: 31/338 (9.17%) in the prophylaxis group and 20/334 (5.99%) in the non-prophylaxis group (P=.119). Although female gender, likely diaper use, and positive intra-operative urine culture were each associated with significantly higher odds of stent UTI, prophylactic antibiotic use was not associated with significant reduction in stent UTI in any of these groups. Surgical approach, stent duration, and Foley duration were not associated with stent UTI. Incidence of stent UTI is low overall following pyeloplasty. Prophylactic antibiotics are not associated with lower rates of stent UTI following pyeloplasty even after controlling for risk factors of female gender, likely diaper use, and positive intra-operative urine culture. Routine administration of prophylactic antibiotics after pyeloplasty does not appear to be beneficial, and may be best reserved for those with multiple risk factors for UTI.

Antimicrobial resistance trend of bacterial uropathogens at the university of Gondar comprehensive specialized hospital, northwest Ethiopia: A 10 years retrospective study.

Urinary tract infection and antimicrobial resistance remains the major problem, with significant health and socioeconomic burden, particularly in developing countries. This infection is commonly caused by Gram-negative bacteria, principally by Escherichia coli. So, this study aimed to determine bacterial isolates and antimicrobial resistance trend among patients with urinary tract infection at the University of Gondar Comprehensive Specialized Hospital, Northwest Ethiopia. A retrospective study was conducted from January 1st to February 28th. A ten years (2010-2019) record of urine culture results, the biochemical test and antimicrobial susceptibility test results of isolates were collected from the medical microbiology laboratory register using a checklist. Data quality was checked, entered, and analyzed using SPSS version 23. We have presented results through descriptive tables and graphs. The overall prevalence of urinary tract infection among 4441 patients was 24.1%. Escherichia coli (37.7%), Klebsiella pneumoniae (11.4%), and Staphylococcus aureus (9.1%) were the predominant uropathogens. The infection rate was nearly similar across both sexes but highest in the age group above 60 years. Above 75% of Gram-negative isolates were resistant to ampicillin (92.5%), amoxicillin-clavulanate (80.1%), tetracycline (79.3%), cefuroxime (79.2%), and Trimethoprim-sulfamethoxazole (78.3%). Over 2/3 of Gram-positive isolates also showed increased resistance to tetracycline (84.8%) and penicillin (71.6%). Moreover, more than 44% of the isolates were multidrug-resistant (MDR). We have seen an inconsistent trend of antimicrobial resistance, with an overall resistance rate of above 50%. In conclusion, the overall prevalence of urinary tract infection was high and elderly patients were most affected. More than 70% of both Gram positive and gram-negative isolates were resistant to penicillin, ampicillin, amoxicillin-clavulanate, tetracycline, cefuroxime, Trimethoprim-sulfamethoxazole. Above than 44% of the isolates were multidrug-resistant (MDR). The increasing rate of antimicrobial resistance calls for routine diagnosis and antimicrobial susceptibility testing. A prospective multicenter study indicating the status of resistance should be encouraged.

Clinical guidelines of UTIs in children: quality appraisal with AGREE II and recommendations analysis

ObjectiveTo explore the current Chinese and English guidelines of urinary tract infection (UTI) in children and provide a summary of the recommendations of the guidelines.MethodsAn electronic search was conducted on...

Effect of asymptomatic bacteriuria on readmissions and rate of urosepsis after ureterorenoscopy for urolithiasis

Objective: This study aims to assess whether the rate of readmissions after ureterorenoscopy (URS) is dependent on results of urine microscopy, culture and sensitivity (MC&amp;S) or nitrite dipstick test performed before the procedure. Patients and Methods: All patients attending for ureteroscopy for stone disease over 12 months were included and had urine dipstick performed immediately prior to the surgery with mid-stream urine (MSU) sample sent for culture. Asymptomatic bacteriuria (ABU) was not treated before ureteroscopy. All included patients received standard antibiotic prophylaxis. Readmissions within 30 days of the procedure were evaluated. Results: A total 120 ureteroscopies were included, of which 20% had ABU. Eight patients (6.67%) were readmitted due to all procedure-related complications; among them, five (4.17%) were readmitted with urinary tract infection (UTI). Readmission rates with UTIs were similar for patients with sterile urine and those who had untreated ABU. Of those patients who were readmitted with UTI, all had a negative nitrite result on preoperative urine dipstick specimens. Most patients (54.17%) who had ABU also had a negative urinary nitrite test. Conclusions: Screening and routine treatment of ABU before ureteroscopy for urolithiasis may be unnecessary provided patients have standard antibiotic prophylaxis. Moreover, urine nitrite testing before ureteroscopy may not be a useful screening test for ABU before ureteroscopy. Level of evidence: 2

120 The Association of Admission Cultures with Burn Outcomes

IntroductionBurn patients are susceptible to infections. It is thought that burn wounds are initially sterile and become colonized by commensal and environmental microorganisms. Many burn centers have protocols to routinely screen patients for infection on admission. The ability of culture results to predict outcomes in burn patients has not been examined. In this study, we aim to examine the relationship between admission cultures and burn outcomes. We hypothesize that patients who have positive cultures on admission will have increased mortality and length of stay (LOS).MethodsA retrospective chart review was conducted using electronic medical records for all adult patients admitted to three ABA verified burn centers from January 2016 -December 2017. Data collected included patient demographics, burn injury, burn outcomes, and cultures obtained within the first 24 hours of admission. Data analysis was conducted using Chi-square, Fisher Exact, Spearman Correlation, Wilcoxon 2-sample, and Kruskal-Wallis tests.ResultsA total of 1615 patients (mean age 45.87±17.65 years, 1145 males [70.9%]) were analyzed. Mean total body surface area burn (TBSA) was 9.6±14.2% and 10% had inhalation injuries. In this study population, the median LOS was 7 days (Interquartile range [IQR] = 12) and 72 patients (4.5%) expired. Older patients (p < .0001), those with higher scores on the 11-factor modified frailty index (mFI-11) (p < 0.0001), a higher TBSA (p< .0.0001) and inhalation injury (p < 0.0001) had a higher mortality rate. In examining the effect of admission cultures on mortality, there was no significant difference in mortality based on wound culture (p 0.14), Clostridium difficile (C. diff) (p 0.25), or urine culture (p=0.79) results. Patients with positive Methicillin-Resistant Staphylococcus Aureus (MRSA) screening (p 0.04) and those with positive blood cultures (p 0.01) were more likely to die from their injuries. Older patients (r= 0.14, p < 0.0001), those with a larger TBSA (r=0.49, p < 0.0001), and a higher MFI-11 score (r=0.12, p < 0.0001) had and increased LOS.. There was no association between LOS and positive wound cultures (p 0.08), or blood cultures (p 0.49) upon admission. Patients with positive MRSA results (p 0.003) and urine cultures (p 0.01) upon admission had a longer LOS while those with positive C. diff results had a shorter LOS (p 0.01).ConclusionsMortality is associated with standard predictors of outcomes (age, burn size, inhalation injuries, frailty scores) and positive MRSA screens and blood cultures. Patients with larger burns (define larger burn-maybe use the degree scale), a positive MRSA and negative C. diff had a longer LOS. Based on these results, cultures should be considered in all patients upon admission to the hospital as they are predictive of burn outcomes.