Risk Factors For UTI Research Articles

176 - Prospective, observational study of the prevalence and risk factors for UTI following Onabotulinum Toxin A injections for Idiopathic OAB

176 - Prospective, observational study of the prevalence and risk factors for UTI following Onabotulinum Toxin A injections for Idiopathic OAB

Prevalence and Risk Factors of Multidrug-Resistant Urinary Tract Infections among Critically Ill Patients in Ain Shams University Hospitals

Abstract Background Multidrug-resistant infections are becoming a major source of in-hospital mortality and morbidity in ICU patients, numerous independent risk factors for infections by MDR bacteria have been identified, ICUs are often considered the epicenter of development, amplification and dissemination of drug-resistant microorganisms Aim and Objectives To determine the prevalence, possible risk factors and outcome in critically ill patients in ICU with multidrug resistant urinary tract infections in Ain Shams University Hospitals. Subjects and Methods This was cross-sectional study that included 383 patients who were admitted to different intensive care units in Ain Shams university hospitals during a period of Six months (March 2022 – August 2022). Patients were identified by review of urine specimens sent to the microbiology laboratory for urine cultures, for patients suspected clinically of UTI or in those with urinalysis demonstrating increased white blood cells count, Multidrug resistant (MDR) was defined as isolates that were resistant or intermediate susceptible to ≥ 3 of the following antimicrobial categories: (a1) penicillin (b) cephalosporins (c) carbapenems; (d) fluoroquinolones; (e) gentamicin or amikacin; (f) TMP-SMX; and (g) nitrofurantoin Results The prevalence of multi- drug resistant UTI was about 45.2%. Hypertension and Diabetes mellitus were the most common medical comorbidities. The presence of chronic indwelling urinary catheters was the most common healthcare-associated risk factor for MDR UTI. Klebsiella and enterococcus were significantly more prevalent among MDR cases (41.6 % and 46.8% respectively). Penicillin had the most common antimicrobial resistance in our study. 59% of the patients with MDR UTI presented with septic shock, 18.5% presented with AKI as the second most common cause of hospital admission in MDR UTI patients. MDR UTI patients had higher mean serum creatinine and lower eGFR in comparison to non-MDR group. Conclusion Multi- drug resistant UTI had 45.2% prevalence among critically ill patients in Ain Shams university hospitals with many risk factors. In addition, higher CRP, lower eGFR and lower haemoglobin level are associated with MDR urinary tract infections.

P13 Predictive value of urinalysis and urine culture in bacteraemic adults without localizing urinary features: a retrospective cohort study

Abstract Background Urinalysis (UA) and urine culture (UC) are commonly used in patients with bacteraemia to diagnose a urinary focus of infection. The predictive value of these investigations in patients without localizing urinary features is uncertain. We hypothesized that UA/UC would have extremely low predictive value in patients with bacteraemia and neither localizing urinary features nor risk factors for bacteraemic UTI (bUTI). Methods This was a retrospective cohort study of hospitalized adults with community-onset bacteraemia in 2019 at Middlemore Hospital (Auckland, New Zealand). The suspected focus of infection at first assessment was determined by reviewing clinical notes from the initial presentation using the admitting clinician’s preferred diagnosis plus at least one supportive clinical feature. The final diagnosis of focus of bacteraemia (bUTI versus non-urinary) was determined by investigators based on blood and urine culture concordance, with supportive clinical, laboratory or imaging features. Defined localizing urinary features were determined by investigators from notes. Positive and negative predictive value of UA/UC for diagnosing bUTI was calculated among those with initially unclear or non-urinary focus of infection. Univariate analysis was performed for patients with initially unclear focus of infection, for risk factors associated with final diagnosis of bUTI. Results In total, 871 patients were included. The admitting clinician’s suspected focus was urinary in 219, unclear in 304 and non-urinary in 348. A final diagnosis of bUTI was found in 342 (39.3%), of whom 110 (32.2%) lacked any localizing urinary features. After excluding localizing urinary features, bUTI was diagnosed in 98/243 (40.3%) with initially unclear focus and 12/326 (3.7%) with suspected non-urinary focus. UA/UC PPV was 5.2%/25%, respectively, when initial focus was non-urinary, but 51.5%/75% when initial focus was unclear. Amongst patients with initially unclear focus, risk factors for bUTI included age >75, urinary catheter/nephrostomy, invasive urologic procedure within 3 months and cognitive impairment. However, of those with bUTI, 22/98 (22.4%) had none of these risk factors. Conclusions bUTI occurs in a significant minority of bacteraemic patients where initial focus is unclear and where localizing urinary features are absent, including in patients without associated risk factors. UA/UC is a reasonable investigation in bacteraemia of uncertain focus, but results should be interpreted cautiously. UA has excellent NPV but very poor PPV. Among patients with bacteraemia, initially suspected non-urinary focus of infection, and without localizing urinary features, UA/UC can be safely withheld and bUTI is very uncommon. A prospective study using initial clinical criteria would provide more relevant predictive values for clinicians.

The Appropriateness of Empirical Antimicrobial Treatment of Uncomplicated Urinary Tract Infection in Adult Female Patients in Jazan Region, Saudi Arabia.

Uncomplicated urinary tract infection (uUTI) is one of the most prevalent bacterial infections in clinical practice. Empirical treatment is used commonly; thus, knowledge of the local antimicrobial susceptibility pattern is crucial to avoid the growing antibiotic resistance. The aim of this study is to evaluate the effectiveness of the empirical treatment of uUTI and determine the susceptibility pattern for common uUTI causative microorganisms at outpatient clinics in hospitals in the Jazan region. This is a prospective observational study of 120 patients with uncomplicated urinary tract infections attending internal medicine outpatient clinics in Al-Hayat Jazan hospital, Saudi Arabia, from September 2021 to January 2023. In total, 120 patients were included in the study. The mean age of the participants was 48.53 ± 9.29. Risk factors for UTI were found in 57.5%, and type 2 diabetes mellitus (DM) was the major risk factor (27.5%). The most common causative microorganism was Escherichia coli (E. coli) (87.5%), followed by Klebsiella pneumoniae (5%), Staphylococcus aureus, Enterobacter spp., and Enterococcus spp. (2.5%). Nitrofurantoin was the most effective antimicrobial agent (sensitivity rate of 91.7%) against all microorganisms, followed by Ciprofloxacin (75%). This study concluded that nitrofurantoin and Ciprofloxacin are suitable empirical treatments for uncomplicated urinary tract infection in the Jazan region, and increased resistance against trimethoprim/sulphamethoxazole (TMPSMX) and cefaclor was observed; thus, empirical therapy with these agents should be reconsidered in local guidelines. Wide surveillance research is necessary to monitor effective empirical therapies and to evaluate the regional antimicrobial susceptibility pattern.

Incidence and risk factors for urinary tract infection in the first year after kidney transplantation at 108 Military Central Hospital, Vietnam

Objective: To determine the incidence of urinary tract infections in kidney transplant patients in our hospital, to identify the microbial pathogens, risk factors for urinary tract infection. Subject and method: Primary kidney transplant patients at 108 Military Central Hospital with full follow-up records in the first year were included in the study. Age, sex, cause of kidney failure, pre-transplantation treatment measures, post-transplantation immunosuppressive regimen were collected. Patient was followed and midstream urine was cultured monthly. Result: There were 94 kidney transplant patients included in our study. Seventy patients (74.5%) were male and 24 (25.5%) were female. One hundred and two episodes of urinary tract infections in 37 patients (39.4%) were reported. Sex (female) (p=0.003; 95% CI: 1.716-14.021), urologic complications (p=0.006, 95% CI: 0.001-0.320) were found as risk factors for UTI in the first year of transplantation. Escherichia coli and Klebsiella pneumoniae were the most frequently isolated pathogens. UTI had no negative impact on short-term graft survival. Conclusion: The results of our study showed a high incidence of UTI in kidney transplant recipients. Infection control methods should be used regularly during post-transplant therapy.

The influence of indwelling double-J stent duration prior to URS on postoperative complicated urinary tract infections

AbstractUreterorenoscopy and double‑J stents are frequently associated with complicated urinary tract infections (cUTI’s). To date, it remains unclear whether longer indwelling stent duration increases the risk of cUTI’s and recommendations on this subject are therefore lacking. This study investigates whether double‑J stent placement and longer indwelling stent duration prior to URS increase the risk of post-URS cUTI’s. Adult patients undergoing ureterorenoscopy in 2019 were eligible for study participation. Records were retrospectively collected. Potential risk factors were evaluated using multivariate logistic regression models. 16.9% of the prestented patients was diagnosed with a UTI, compared to 7.1% in the non-prestented group (p = 0.034). Female gender, preoperative positive urine cultures and stone recurrence were significant risk factors. This study demonstrated a correlation between preoperative placement of double‑J stents and post-URS complicated UTI’s. However, neither preoperative double‑J stent placement nor longer indwelling stent time was a significant risk factor for postoperative complicated UTI’s.

FACTORES DE RIESGO NUTRICIONALES ASOCIADOS A INCONTINENCIA URINARIA Y SU IMPACTO SOBRE LA CALIDAD DE VIDA EN MUJERES ADULTAS

Introduction: There is evidence in the literature studies about nutritional factors that could increase the risk of developing urinary incontinence (UI), which significantly impairs the quality of life of patients. Objectives: To identify nutritional risk factors associated with UI in adult women and its impact on quality of life. Materials and methods: Cross-sectional, observational and analytical study of cases and controls, on a non-probabilistic, intentional and voluntary sample of adult women (35 to 75 years old), who attended Centro de Kinesiología y Estética (Esteban Echeverría, Province of Buenos Aires). Thirty women with UI (cases) were identified by ICIQ-SF (International Consultation on Incontinence Questionnaire), and controls without UI, obtained from the same population base (n=30), were matched one by one. Variables under study: age, nutritional risk factors for UTI: nutritional status by Body Mass Index (BMI) and waist circumference (WC); hygienic-dietary habits: sedentary lifestyle (exercise <150 minutes/week), functional constipation according to ROME IV criteria and increased fluid intake (≥ recommendation); UTI impact on quality of life by Potenziani- 14-CI- IO- QOL- 2000 questionnaire. Statistical analysis using SPSS 19.00 calculating measures of central tendency, Chi-square and Odds Ratio (OR) with 95% confidence intervals and significance p<0.05. Results: Most women with UTI were sedentary (86.7%) with overweight or obesity (66.7%) and increased CC (73.7%). UI was associated with age (OR=0.32; 95%CI: 0.11-0.94; p=0.03), overweight/obesity (OR=0.15; 95%CI: 0.04-0.47; p=0.001), increased QoL (OR=0.11; 95%CI: 0.03-0.42; p=0.0001) and sedentary (OR=0.20; 95%CI: 0.059-0.695; p=0.02). The impact on quality of life was mild-moderate for most women with UI (93.3%). Conclusion: Age, overweight or obesity, increased waist circumference and sedentary lifestyle were risk factors associated with UI. An adequate nutritional intervention would improve the quality of life of adult women with this condition. Keywords: Urinary incontinence; adult women; risk factors; life quality.

PREVALENCE AND MANAGEMENT OF URINARY TRACT INFECTIONS IN TYPE 2 DIABETIC PATIENTS

Diabetes mellitus (DM) is a polygenic illness that affects many other organs. In people with type 2 diabetes, urinary tract infection is the most prevalent, the most severe, and has the worst consequences. They are also more frequently caused by microorganisms that are resistant to antibiotics. Immune system dysfunction, poor metabolic regulation, and inadequate bladder emptying owing to autonomic neuropathy may all contribute to these individuals' increased risk of urinary tract infections. The novel anti-diabetic sodium glucose cotransporter 2 inhibitors were not shown to raise the likelihood of symptomatic urinary tract infections appreciably. Urinary tract infection symptoms are comparable to those seen in people without diabetes, while some patients with diabetic neuropathy may exhibit changed clinical findings. The existence of symptoms, the severity of systemic symptoms, whether the infection is limited in the bladder or also includes the kidney, the presence of urologic abnormalities, concomitant metabolic disturbances, and renal function all influence treatment. There is no evidence that diabetic people with asymptomatic bacteriuria should be treated. Diabetes length, age, gender, method of drug administration, kind of medicines used in diabetes, poor glycemic control, obesity, unsanitary settings, sexual intercourse, and type of DM are all risk factors for UTI in diabetic patients. Antibiotic usage on a daily basis has rendered numerous harmful microorganisms resistant to their effects. In the long run, if UTI in diabetes people is not treated, it might lead to serious problems. Furthermore, the pattern of antibiotic resistance varies by geographical area. As a result, the use of susceptible antibiotics to treat UTI in diabetes patients has become critical. Medline and PubMed public database searches was carried out for papers written all over the world on UTI in diabetic patients. No predictive analytics technology was used. To evaluate the initial results and the methods of conducting the paper, the group members reviewed the data.

Urological Management of the Spinal Cord-Injured Patient: Suggestions for Improving Intermittent Catheterization and Reflex Voiding

Spinal cord injury can either be complete with no neural communication across the injury level or incomplete with limited communication. Similarly, motor neuron injuries above the sacral spinal cord are classified as upper motor neuron injuries, while those inside the sacral cord are classified as lower motor neuron injuries. Specifically, we provide recommendations regarding the urological management of complete upper motor neuron spinal cord injuries; however, we also make limited comments related to other injuries. The individual with a complete upper motor neuron injury may encounter five lower urinary tract conditions: first, neurogenic detrusor overactivity causing urinary incontinence; second, neurogenic detrusor underactivity resulting in high post-void residual volumes; third, detrusor sphincter dyssynergia, which is contraction of striated and/or smooth muscle urethral sphincters during detrusor contractions; fourth, urinary tract infection; and fifth, autonomic dysreflexia during detrusor contractions, which produces high blood pressure as well as smooth muscle detrusor sphincter dyssynergia. Intermittent catheterization is the recommended urinary management method because it addresses the five lower urinary tract conditions and has good long-term outcomes. This method uses periodic catheterizations to drain the bladder, but also needs bladder inhibitory interventions to prevent urinary incontinence between catheterizations. Primary limitations associated with this management method include difficulties with the multiple catheterizations, side effects of bladder inhibitory medications, and urinary tract infections. Three suggestions to address these concerns include the use of low-friction catheters, wireless, genital-nerve neuromodulation for bladder inhibition, and consideration of urine egress into the urethra as a risk factor for UTI as well as egress treatment. The second management method is reflex voiding. This program uses external condoms for urine collection in males and diapers for females. Suprapubic tapping is used to promote bladder contractions. This method is not recommended because it has high rates of medical complications. In particular, it is associated with high detrusor pressure, which can lead to ureteral reflux and kidney pathology. Botulinum toxin injection into the urethral striated sphincter can manage detrusor sphincter dyssynergia, reduce voiding pressures, and risks to the kidney. We suggest a modified method for botulinum toxin injections as well as five additional methods to improve reflex voiding outcomes. Finally, the use of intermittent catheterization and reflex voiding for individuals with incomplete spinal injuries, lower motor neuron injuries and multiple scleroses are briefly discussed.

Spectrum Of Antimicrobial Susceptibility Pattern of Urinary Tract Infection in In Adults

Patients of all ages and genders regularly experience urinary tract infections. Antibiotic misuse has caused organisms to develop drug resistance, creating a treatment problem. Objective: To uncover risk variables and relationships, as well as the antibiotic susceptibility in UTI patients. Methods: Diabetes and non-diabetes with UTI were compared within groups using the Chi-square test, with a significant P-value of 0.05. Results: 32 (21.2%) were given empirical treatment with ciprofloxacin (11%), cefixime (5%), ceftriaxone (2.6%), cefoparazone-sulbactum (1.30%), amoxicillin-clavulanic acid (1.30%), ampicillin (1.30%), and co-trimoxazole (0.60%), respectively. E. coli was the most prevalent pathogen, with an isolation rate of 84%, followed by pseudomonas aeruginosa (6%), Serratia (3.3%), klebsiella (2.6%), Enterobacter cloacae (2.6%), Sternotophomus (0.7%), and MRSA (each in 0.7%). Ampicillin, Cefixime, Ceftriaxone, Co-Trimoxazole, Ciprofloxacin, Amoxicillin-Clavulanic Acid, Tetracycline, and Levofloxacin were all often resistant to, respectively, 87 percent, 83 percent, 78 percent, 78 percent, and 51 percent of these antibiotics. Conclusions: MDR prevalence is highest in gram-negative bacteria. The presence of diabetes mellitus and being a woman are significant risk factors for UTI, according to tests. Escherichia coli (84%) is the most common uropathogen. Carbapenems, piperacillin-tazobactam, Amikacin, Gentamicin, and cefoparazone-sulbactam (parenteral) as well as Nitrofurantoin are the preferred empirical treatments (oral). Hospitals and the nation at large should constantly examine and reassess their antimicrobial policies.

Percutaneous Nephrostomy in Complicated Urinary Tract Infections.

BackgroundThe study aimed to determine the various indications for percutaneous nephrostomy (PCN) primarily in patients with a urinary tract infection and to determine the various complications arising in these patients due to the procedure.Materials and methodsA retrospective study of five-year data based on registers of the Department of Urology was performed. Among 716 patients, 226 inpatient data were obtained, curated, and analyzed. Indications for PCN, the periprocedural complications, the PCN's duration, details of antibiotics, risk factors for UTI, development of acute kidney injury, and renal replacement therapy were recorded.ResultsPatients were mostly female (53.1%, n=120/226). Malignancy (n=109, carcinoma cervix=68/109) and nephrolithiasis (n=70) contributed to 79.2%. Infections such as pyelonephritis, renal abscess, perinephric abscess, and genitourinary tuberculosis were identified in 47. Infectious diseases were significantly associated with younger age, female gender, diabetes, and prior pyelonephritis. PCN was placed at a median of two days after admission, and bilateral PCN was placed in 36 (15.2%) patients. Hydroureteronephrosis (probably infected) was an indication for PCN in 164/226 patients. In 33 patients with an infectious disease, PCN was performed for an obstructed urinary system. One major and two minor complications gave a rate of 0.06% for patients with infections, which was less than the accepted threshold of 4%.ConclusionsWe intended to study the utility and problems with placing a PCN catheter in patients with complicated urinary infections. We conclude that PCN is a safe and effective procedure in urinary tract infections with obstructed drainage.

Infección de vías urinarias después de resección transuretral de vejiga: Microbiología, resistencia antibiótica y factores de riesgo asociados.

Objective: Investigate the microbiology and incidence of drug resistance in patients undergoing TURBT and to identify independent risk factors for UTI following surgery.
 Material & Methods : Retrospective observational study of prospectively collected data of 199 patients who underwent TURBT in a tertiary care center in Mexico City between 2017-2019. Baseline characteristics and microbiological data (frequency of isolated bacteria and antibiotic resistance pattern) were analyzed according to the presence of UTI following surgery. Binary logistic regression analysis was performed to identify independent risk factors for UTI.
 Results: A preoperative positive urine culture (PUC) was present in 28 patients (14%), the most common isolated pathogens were Escherichia coli(48%), Enterococcus faecalis(24%) and Proteus mirabilis(7%). UTI was documented in 20 patients after TURBT (10%), being E. coli(45%) the most common uropathogen which was resistant to Trimethoprim/Sulfamethoxazole(60%) and Ciprofloxacin(40%). Other common isolated pathogens were E. faecalis(27%) and P. mirabilis(9%). There was significant difference in the presence of a PUC before TURBT and necrosis (p=0.001). On the multivariate analysis the PUC before TURBT was associated with UTI after TURBT (OR7.04 [95%CI 2.11-23.29]).
 Limitations: Retrospective study with information limited to the clinical file.
 Originality: There is little information about UTI after TURBT in global literature, in Mexico there is no information, being this study unique in his kind.
 Conclusions: The incidence of UTI after TURBT was 10%. The strongest associated risk factor for UTI after TURBT was a preoperative PUC. The most common isolated uropathogen was E. coli. Trimethoprim/Sulfamethoxazole(60%) and Ciprofloxacin(40%) were the most resistant antibiotics for E. coli.

Frequency of urinary tract infections in renal transplant recipients with common bacteria and its sensitivity

Objective: To determine the frequency of urinary tract infection and its common pathogens with antibiotic sensitivity among renal transplant recipients.
 Materials and methods:
 This Cross sectional descriptive study was conducted at Institute of Kidney Diseases (IKD) Hayatabad, Peshawar from January 2008 to December 2012. The cross section included 74 live related renal transplant recipients. Each renal transplant recipient was followed up for 3mpnths for developing urinary tract infection.
 Results: 
 A total of 74 patients were followed after renal transplant. Among them 12 (16.22%) were females and 62 (83.78%) were males respectively. They were all live related renal transplant. UTI developed in 27/74 (36.48%) patients at first 3 months after transplantation (60 ± 15 days). Female patients were more susceptible to UTI than male patients (5 female 41.66%; 22 male 35.48%). On univariate analysis, older age (p?=?0.015), female gender (p?<?0.001), hyperglycaemia (p?=?0.037) and acute rejection episodes (p?=?0.046) were all risk factors for developing urinary tract infection. Isolated bacteria were Escherichia coli (59.25%), Candida albicans (18.51%), Klebsiella (11.11%), Enterococcus spp. (7.40%), followed by Pseudomonas aeruginosa 3.70%. Antibiotic resistance was 26% for ciprofloxacin and 33% for ampicillin.
 Conclusion: Urinary tract infection is a major problem in renal transplant recipients. The female gender, increasing age and uncontrolled hyperglycemia are the risk factors for UTI in renal transplant recipients. There is high resistance to ampicillin and quinolones in renal transplant recipients.
 

Prediction Model for Urinary Tract Infection in Pediatric Urological Surgery Patients

BackgroundUrinary tract infection (UTI) is a common complication in pediatric urological surgery patients and is associated with long-term sequelae, including subsequent recurrent infections and renal scarring. In this study, we aimed to explore the risk factors for UTI in pediatric urological surgery patients and construct a predictive model for UTI.Materials and MethodsA total of 2,235 pediatric patients who underwent urological surgery at a tertiary hospital between February 2019 and January 2020 were included. A multivariate logistic regression model was applied to identify the predictive factors, and a predictive model was constructed using a receiver operating characteristic curve. A multifactorial predictive model was used to categorize the risk of UTI based on the weight of the evidence.ResultsA total of 341 patients with UTI were identified, which corresponded to a prevalence of 15.26% in pediatric urological surgery patients. Multivariate analysis identified six significant risk factors for UTI, including age <12.0 months, upper urinary tract disease, not using an indwelling drainage tube, hospital stay ≥10 days, administration of two or more types of antibiotics, and stent implantation. A combination of the aforementioned factors produced an area under the curve value of 88.37% for preventing UTI in pediatric urological surgery patients. A multifactorial predictive model was created based on the combination of these factors.ConclusionsThe constructed multifactorial model could predict UTI risk in pediatric urological surgery patients with a relatively high predictive value.

Impact of Carbapenem Peri-Transplant Prophylaxis and Risk of Extended-Spectrum Cephalosporin-Resistant Enterobacterales Early Urinary Tract Infection in Kidney Transplant Recipients: A Propensity Score-Matched Analysis.

BackgroundUrinary tract infection (UTI) is the most common bacterial infection after kidney transplantation (KT), leading to unfavorable clinical and allograft outcomes. Gram-negative uropathogenic bacteria are frequently encountered especially extended-spectrum cephalosporin-resistant (ESC-R) Enterobacterales (EB), causing UTI early after KT.MethodsA retrospective single transplant study was conducted between January 2016 and December 2019. We performed 1:1 nearest-neighbor propensity score matching without replacement using recipient age, recipient sex, induction, transplant year, human leukocyte antigen, cold ischemia time, and panel-reactive antibody before analyses. Cumulative incidence of ESC-R EB early (within 14 days after KT) UTI was estimated by the Kaplan–Meier method. Risk factors for ESC-R EB early UTI were analyzed by a Cox proportional hazards model. Variables measured after transplantation were considered time-dependent covariates.ResultsWe included 620 KT recipients (37% women; mean age ± SD, 43 ± 11 years). Overall, 64% and 76% received deceased-donor allograft and induction therapy. Sixty-five (10%) and 555 (90%) received carbapenems and cefuroxime peri-transplant prophylaxis, respectively. Early UTI occurred in 183 (30%) patients, 52% caused by ESC-R EB. Propensity score matching produced 65 well-balanced pairs. During a 14-day follow-up, the cumulative incidence of ESC-R EB early UTI was 5 and 28% in the carbapenems and cefuroxime groups, respectively (log-rank test = 0.003). Peri-transplant carbapenems prophylaxis was a protective factor against ESC-R EB after KT (hazard ratio, 0.19; 95% confidence interval, 0.05–0.64; p = 0.008). Clinical and allograft outcomes did not differ significantly between the groups.ConclusionsIn the setting where ESC-R EB UTI is common among KT recipients, carbapenems peri-transplant prophylaxis could protect against the occurrence of early ESC-R EB UTI after KT. Further prospective studies should focus on this specific infection prevention strategy.

International travel and travelers’ diarrhea – Increased risk of urinary tract infection

BackgroundUrinary tract infections (UTIs) rank among the most common infections encountered in health care, with an annual incidence of 12% for women. Despite the vast numbers of international travels (over 1.5 billion annually), no prospective studies have had primary focus on UTIs during travel. MethodsWe recruited in 2008–17 international travelers who all filled out pre- and post-travel questionnaires. Incidence rates of UTI were calculated separately for both sexes. Multivariable analyses were conducted to identify risk factors for UTI during travel. ResultsIn total 15/517 (2,9%) travelers acquired UTI during travel, yielding an annual incidence of 62% for female and 18% for male travelers. Travelers’ diarrhea (TD) was identified as a factor predisposing to UTI (OR 9.2, 95% CI 1.5–+∞, p = 0.011); all UTI cases were recorded by travelers with TD. ConclusionsTo our knowledge, this is the first prospective study with a primary focus on UTI during travel. Our data reveal that among travelers the incidence of UTI far exceeds that reported for the general population. TD was identified as a major risk factor for the infection. Our results suggest TD prevention as a means of also preventing UTI during travel.

Antimicrobial Resistance Patterns, Extended-Spectrum Beta-Lactamase Production, and Associated Risk Factors of Klebsiella Species among UTI-Suspected Patients at Bahir Dar City, Northwest Ethiopia.

Introduction Klebsiella species cause pneumonia, UTI, and septicemia in human beings. Beta-lactam drugs are used extensively to treat patients infected with Klebsiella, but most of the Klebsiella species are resistant to third- and fourth-generation cephalosporins and monobactams to which data are scarce in the study area. Objective To determine the prevalence, antimicrobial resistance, ESBL production, and associated risk factors of Klebsiella species among UTI-suspected patients in Bahir Dar City, Northwest Ethiopia. Methods A multi-institution-based prospective cross-sectional study was conducted from January to May 2019. Midstream urines were collected from 385 patients and inoculated onto CLED and MacConkey agars. Identification of growth was done by a battery of biochemical tests. Antimicrobial resistance and ESBL production patterns were determined by using the disc-diffusion method on Mueller–Hinton agar. Quality of data was maintained by following SOPs and using Klebsiella pneumoniae (ACTT700603). Logistic regression statistical analysis was done using the SPSS, version 25, statistical package. A pvalue ≤ 0.05 was considered statistically significant. Results The median age of the study participants was 32 years. Majority of them were female, urban residents, and unable to read and/or write. The total Klebsiella species detected were 38 (9.9%). Of which, 25 (65.8%) were Klebsiella pneumoniae, followed by 6 (15.8%) Klebsiella ozaenae. 20 (80%), 19 (76%), and 19 (76%) Klebsiella pneumoniae showed resistance to amoxicillin/clavulanic acid, ampicillin, and cotrimoxazole, respectively. All K. oxytoca were resistant to ampicillin, and all K. rhinoscleromatis were resistant to cefoxitin and cefotaxime. Klebsiella species that showed resistance to ≥3 antimicrobials were 26 (68%). ESBL-producing Klebsiella species were 10 (26.3%). Patients who had history of antibiotic use, hospitalization, and tight dressing habit had more risk of getting UTI (p < 0.05) than their counterparts. Conclusions Overall UTI prevalence in our study was lower than that of previous Ethiopian studies. High MDR and ESBL-producing Klebsiella species were detected. Patients' history of antibiotic use, hospitalization, and tight dressing habit were risk factors for UTI. It calls up for improving prevention/control systems of Klebsiella species.

Evaluation of Microalbuminuria in Patients with Urinary Tract Infection

Background: Urinary tract infection is a collective term for infections that involve any part of the urinary tract. It is one of the most common infections in local primary care. There are wide range of factors identified that can increase susceptibility to UTI, like sexual intercourse, congenital abnormalities, urinary obstruction, prior history of UTI, diabetes, urogenital surgery, estrogen deficiency. Diabetes mellitus has been a significant risk factor for complicated UTI. Presence of microalbumin in urine in patients of urinary tract infection may be a predictor of intrinsic renal pathology and its presence is a predictor of ongoing progressive damage to kidneys. Microalbuminuria is also associated with cardiovascular events and diabetic nephropathy. Early diagnosis of microalbuminuria will decrease the incidence of end stage renal disease and cardiovascular events. The present study was thus conducted to evaluate prevalence of microalbuminuria in patients diagnosed with urinary tract infections.Material &amp; Methods:The present hospital based case control study was conducted on 60 patients visiting the outpatient clinic (OPD) of Department of Urology, Government Medical College and Rajindra Hospital, Patiala and diagnosed with UTI and the control group consisted of 20 age and gender matched individuals. Estimation of urine microalbumin was done by Enyme linked immunoassay(ELISA) kit method in Department of Biochemistry, GMC Patiala.Results:Out of 60 cases of UTI included in the present study, prevalence of microalbuminuria was observed in 43.3% among cases of UTI . A total of 85% of the cases with positive urine culture had microalbuminuria (p&lt;0.01).Conclusions:Microalbuminuria and ACR can be recommended for predicting ESRD at an early stage of kidney disease.

Sociodemographic Inequalities in Urinary Tract Infection in 2 Large California Health Systems.

BackgroundUrinary tract infection (UTI) accounts for a substantial portion of outpatient visits and antibiotic prescriptions in the United States. Few studies have considered sociodemographic factors including low socioeconomic status (SES)—which may increase residential crowding, inappropriate antibiotic prescribing, or comorbidities—as UTI or multidrug-resistant (MDR) UTI risk factors.MethodsWe used 2015–2017 electronic health record data from 2 California health care systems to assess whether 3 sociodemographic factors—use of Medicaid, use of an interpreter, and census tract–level deprivation—were associated with overall UTI or MDR UTI. UTIs resistant to ≥3 antibiotic classes were considered MDR.ResultsAnalyses included 601 352 UTI cases, 1 303 455 controls, and 424 977 urinary Escherichia coli isolates from Kaiser Permanente Southern California (KPSC) and Sutter Health in Northern California. The MDR prevalence was 10.4% at KPSC and 12.8% at Sutter Health. All 3 sociodemographic factors (ie, use of Medicaid, using an interpreter, and community deprivation) were associated increased risk of MDR UTI. For example, using an interpreter was associated with a 36% (relative risk [RR], 1.36; 95% CI, 1.31 to 1.40) and 28% (RR, 1.28; 95% CI, 1.22 to 1.34) increased risk of MDR UTI at KPSC and Sutter Health, respectively, adjusted for SES and other potential confounding variables. The 3 sociodemographic factors were only weakly associated with UTI overall.ConclusionsWe found low SES and use of an interpreter to be novel risk factors for MDR UTI in the United States.

Epidemiology and risk factors for ureteral stent-associated urinary tract infections in non-transplanted renal patients: a systematic review of the literature

Pathophysiology and risk factors for Ureteral Stent-Associated Urinary Tract Infection (USAUTI) have been poorly investigated. This situation results in highly diverse practices regarding USAUTI prevention, diagnosis and treatment. The aim of the present study was to describe the epidemiology and risk factors for USAUTI in non-transplanted patients. We conducted a systematic literature review based on a comprehensive PubMed® bibliographic strategy, between October 1998 and March 2020. The methodological quality of the studies included was analyzed according to dedicated grids. The main endpoints were the correlation between different potential risk factors and infection ureteral stent-associated urinary tract infection or colonization rate. Conclusions and their level of evidence were reported on the basis of a critical analysis of the best available scientific evidence. This work has been submitted to a national review, which enabled the potentially divergent opinions of experts to be collected, thereby ensuring adequate quality of data. Twenty-six studies out of the 505 articles identified, were included in the final analysis. Staphylococcus spp, E. coli, Klebsiella spp, Pseudomona aeruginosa, Enterococcus spp. and Candida spp. were the microorganisms most often responsible for asymptomatic bacteriuria (ABU) or USAUTI. Longer indwelling time, diabetes mellitus, female gender, chronic renal failure, diabetic nephropathy and cancer were identified as risk factors for ABU and ureteral stent colonization. No specific risk factor for UTI was identified in the literature studied. A causal relationship between ureteral stent colonization and USAUTI or urosepsis remains to be demonstrated.