Risk Of UTI Research Articles

Nanoscale surface modification favors benign biofilm formation and impedes adherence by pathogens

We have found in vitro that a biofilm of benign Escherichia coli 83972 interferes with urinary catheter colonization by pathogens, and in human studies E. coli 83972–coated urinary catheters are associated with lower rates of catheter-associated urinary tract infections. We hypothesized that modifying surfaces to present mannose ligands for the type 1 fimbriae of E. coli would promote formation of dense E. coli 83972 biofilms, thereby interfering with surface colonization by Enterococcus faecalis, a common uropathogen. We covalently immobilized mannose on silicon substrates by attaching amino-terminated mannose derivative to carboxylic acid–terminated monolayers via amidation. Fluorescence microscopy showed that E. coli 83972 adherence to mannose-modified surfaces increased 4.4-fold compared to unmodified silicon surfaces. Pre-exposing mannose-modified surfaces to E. coli 83972 established a protective biofilm that reduced E. faecalis adherence by 83-fold. Mannose-fimbrial interactions were essential for the improved E. coli 83927 adherence and interference effects. From the Clinical EditorRecurrent urinary tract infections remain major adverse events associated with catheter use. The authors report that modifying catheter surface to present mannose ligands for the type 1 fimbriae of benign Escherichia coli 83972 promotes formation of dense E. coli biofilms, which 100-fold reduces urinary catheter colonization of uropathogens. Future application of this technology is expected to result in substantial UTI risk reduction in catheter users.

The natural history of urinary tract infection in women

Many women who suffer from the symptoms of urinary tract infection have a negative urine culture when conventional methods are used. Their condition is described as 'urethral' (or 'dysuria/frequency') syndrome' (US). As they may be indistinguishable clinically from those with positive cultures antibiotics are often prescribed. Their symptoms are usually recurrent and they may receive many courses of treatment. Some women are said to have 'interstitial cystitis' (IC); they have a long history of symptoms and antibacterial treatment. The urine contains white blood cells (pyuria) and biopsy of the bladder wall shows the histological changes of chronic inflammation. Additional culture techniques applied to urine from these two groups of patients consistently yield bacteria, most commonly lactobacilli in those with US. From the urine of women with IC, lactobacilli and some other 'fastidious' bacteria are isolated from catheter specimens and also from bladder wall biopsies. These bacteria are known to be constituents of the mixed commensal flora of the distal one-third of the urethra. It is proposed that these two syndromes are different stages in the natural history of UTI, and that antibacterial agents, by selection of resistant bacteria in the urethral commensal flora, are an important aetiological factor. It is possible that these bacteria may invade the paraurethral glands via their ducts - a situation analogous to invasion of the prostate in men. There is a considerable body of evidence supporting this hypothesis, but as it all emanates from one centre it needs to be confirmed elsewhere. Acceptance would bring great clinical benefit and considerable financial savings. A laboratory protocol which requires only small additional expenditure, and a clinical management regimen are proposed. At present, much antibacterial treatment is prescribed and many patients undergo radiological and invasive investigations such as cystoscopy and urethral dilatation, the latter incurring the risk of post-instrumentation UTI. There is evidence that 'US' responds gradually if antibiotics are withheld. 'IC' is a more difficult problem because bacteria may have invaded the bladder wall. Carefully targeted antibacterial treatment given for at least 10-14 days might be effective, but there are no data on this. Rational management of 'US' might prevent the development of 'IC'. A recent thorough review of published work on this condition states that the aetiology is still unknown. It appears, however, that no attempt has been made in any recent studies to use urine culture techniques capable of detecting bacteria other than the recognised aerobic pathogens.

Prior Antibiotic Could Increase Resistant UTI Risk

Prior Antibiotic Could Increase Resistant UTI Risk

Total endoscopic management (TEM approach) of children with non-compliant neuropathic bladder: A preliminary report

Purpose We prospectively evaluated the efficacy and durability of a combination of intradetrusor botulinum-A toxin (BTX-A) and endoscopic treatment of vesicoureteric reflux (VUR) to manage children with myelomeningocele (MMC) and non-compliant refluxing bladders who were not responding to standard conservative therapy. We also evaluated whether this combined therapy can lower intravesical pressure, increase bladder capacity, gain social continence and protect the upper tract from recurrent urinary tract infection. Material and methods A total of 10 patients with a mean age of 5.9 ± 3.6 years (range 2–12 years) with MMC (eight females and two males) were prospectively involved in the study. All patients were fully compliant to clean intermittent catheterization, and all were non-responders (failed to gain continence and/or poor compliance) to the maximum tolerable dose of anticholinergics and catheterization. All patients were subjected to cystoscopic intradetrusor injection of 12 U/kg (maximum 300 U) of BTX-A in an infection-free bladder. They all had VUR (16 refluxing ureters, six patients with bilateral VUR) and did not show resolution in the pretreatment voiding cystourethrogram; accordingly, submucosal injection of Deflux ® was performed either with the second BTX-A treatment (initial four patients) or with the first BTX-A treatment (the other six patients). The grade of reflux was G III, IV and V in three, seven and six ureters, respectively. Results The maximum bladder capacity increased significantly from 79 ± 49 to 155 ± 57 ml ( p < 0.022), and the maximum detrusor pressure decreased significantly from 55 ± 16 to 37 ± 11 cm H 2O ( p < 0.001). Fifteen out of 16 (93.75%) refluxing ureters were completely resolved (one of them on second attempt), and one (6.25%) (GV reflux) remained unchanged despite of two attempts. Of six incontinent patients, five reached complete dryness between catheterizations and one showed partial improvement. Conclusions A combination of BTX-A and endoscopic correction of VUR is a simple and effective way to overcome the increased risk of high intravesical pressure and recurrent UTI. This treatment decreases the incidence of renal damage in children on whom conservative management fails to help, in a minimally invasive way.

Outcome of tension-free vaginal tape procedure when complicated by intraoperative cystotomy

The objective of this study was to determine risk factors for intra-operative cystotomy during TVT and whether this affects surgical outcome and morbidity. Charts of 340 women who underwent TVT were reviewed. Those who had a cystotomy during the procedure (cases) were compared with those without (controls) for the variables: age, race, parity, body mass index (BMI), TVT with or without other procedures, previous pelvic surgery, blood loss, length of catheter drainage, UTI, and voiding dysfunction. The t-test and chi-squared test were used and differences resulting in P < .05 were statistically significant. Cystotomy occurred in 49/340 TVT procedures (14.4%). Only those who had a history of abdominal hysterectomy and BMI greater than 26.5 were more likely to have a cystotomy (P = .05 and P = .001, respectively). Cases were more likely to go home with catheter drainage (P = .005). There was no increased risk of UTI or voiding dysfunction, nor was there a difference in surgical cure rate. Cystotomy does not seem to negatively affect the outcome of the TVT procedure.

PREVALENCE AND COMPLICATIONS OF ASYMPTOMATIC BACTERIURIA DURING PREGNANCY

Objective: To study the prevalence and complications ofasymptomatic bacteriuria during pregnancy. Study Design: Descriptive Study (Cross. Sectional). Duration of Study:October 2001 to March 2002. Patients and Methods: There were 3000 houses in Satellite town and extension Beharicolony Bahawalpur. Taking 40% of total, 1200 houses were selected by systemic random sampling and pregnantresidents of these houses were included in the study. Results: 580 ladies fulfilling the inclusion criteria wereinterviewed and tested for bacteriuria by Dip Stick test. 28 women had bacteriuria giving prevalence of 4.8%. Cultureand sensitivity tests showed E-Coli to be the causative organism in 78.6% while 21.4% cases were due to otherorganisms. 35.7% bacteriuric women had positive past history of UTI compared to only 9.7% non-bacteriuric womengiving significant result regarding risk of recurrent infection (p&lt;0.05). Prevalence of anaemia was not much differentin the two groups, 85.7% compared with 82.6%. (p&gt;0.05). Development of PIH was not found to be affected bybacteriuria as 10.7% bacteriuric and 8.9% non bacteriuric women developed PIH (p &gt;0.05). Similarly number of lowbirth weight babies was not much different in the two groups, 7.1% compared with 6.2% (p&gt;0.05). Bacteriuria was foundto be a causative factor for preterm labour as 21.4% bacteriuric women compared with 4.9% non-bacteriuric womenwent into preterm labour (p&lt;0.05). Bacteriuria was found to increase the risk of symptomatic UTI as 14.2% bacteriuricand 2.7% non-bacteriuric women developed cystitis. (p&lt;0.05). CONCLUSION: Asymptomatic bacteriuria is a commoninfection during pregnancy and it increases the risk of symptomatic UTI and preterm birth.

Does Pre-Transplantation Antireflux Surgery Eliminate Post-Renal Transplantation Pyelonephritis in Children?

Antireflux surgery for VUR before renal transplantation decreases the risk of post-kidney transplant UTI in pediatric patients with primary vesicoureteral reflux. We studied the risk of post-kidney transplant UTI in patients with or without surgical correction of VUR before transplantation compared to patients without VUR. We compared 12 patients who had VUR corrected before transplantation (group 1) to 17 patients with VUR who did not undergo antireflux surgery before transplantation (group 2) and 36 patients undergoing renal transplantation without VUR (group 3). A total of 10 patients in group 1 (83.3%) and 10 in group 2 (58.8%) had high grade VUR. Eight patients in group 1 (66.7%), 6 in group 2 (35.3%) and 33 in group 3 (91.7%) remained free of febrile UTI during followup (p = 0.00). Among patients with high grade VUR 6 in group 1 and 1 in group 2 remained UTI-free (p = 0.02). A total of 33 patients in the control group (91.7%) remained free of febrile UTI, an incidence that was significantly lower compared to group 1 (p = 0.03) and group 2 (p = 0.00). Of the patients with high grade VUR 3 in group 1 (30%) and 4 in group 2 (40%) experienced recurrent febrile UTIs (p = 0.64). Even after surgical correction of VUR before transplantation the frequency of febrile UTI remained higher than that in kidney transplant recipients without VUR. In cases of high grade VUR reimplantation before renal transplantation decreased the rate of febrile UTI but it was still higher than the level of risk in the control group.

Antibiotic Resistance Doesn't Raise UTI Risk in Long-Term Care Patients

Antibiotic Resistance Doesn't Raise UTI Risk in Long-Term Care Patients

Antibiotic Resistance Doesn't Increase Risk of UTI

Caring for the Ages is the official newspaper of AMDA and provides long-term care professionals with timely and relevant news and commentary about clinical developments and about the impact of health care policy on long-term care medicine.

Evolution of closed urinary drainage systems use and associated factors in Spanish hospitals

Although closed urinary drainage systems (CUDS) reduce the risk of catheter-associated urinary tract infection (CAUTI), open systems are still used in Spain. The object of this work was to describe the progress of CUDS use and factors associated with the drainage system type used in Spanish hospitals. The databases of the EPINE study (Study of Prevalence of Nosocomial Infections in Spain) from 1990 to 2000 were used. The EPINE study includes hospitalized patients of all ages in acute-care Spanish hospitals. Seventy-six thousand, seven hundred and eighty-eight catheterized patients were studied, and the whole database was used for the trend analysis of global hospital-acquired infection (HAI). The patient and the hospital were the two units of observation used in the analysis. Full implementation was defined as 90% CUDS use. A logistic regression model was applied to study factors influencing the use of CUDS and to determine prevalence trend. An odds ratio (OR) >1 indicates an incremental trend. The Pearson correlation coefficient between annual percentage of CUDS use and CAUTI prevalence was calculated. Variables for the year 2000 were compared using the Mann–Whitney U test between hospitals with and without full implementation. The prevalence of urinary catheterized patients in Spain increased from 12.4% in 1990 to 15.2% in 2000 (OR 1.019, 95% CI 1.016–1.021). The proportion of CUDS used increased from 50.6% in 1990 to 70% in 2000 (OR 1.1, 95% CI 1.095–1.104) and correlated with a significant decrease of UTIs ( r=−0.65, P=0.03). In 1990, 28.5% of hospitals had full implementation of CUDS and by 2000 this had risen to 40.3% (OR 1.093, 95% CI 1.06–1.127). Patients in medium (200–500 beds) and large (>500 beds) hospitals, as well as those with three of more diagnoses and two or more intrinsic risk factors had an increased probability of having a CUDS, whereas being hospitalized in areas other than intensive care, being male and less than 65 years old were associated with a lower probability of CUDS use. The median prevalence of catheterized patients in hospitals with full implementation, was significantly lower than in those without it ( P=0.049). Although CUDS use is increasing, there is still much work required to reach full implementation. Keeping CUDS for more severely ill patients may reflect a higher concern over the consequences of UTI in these patients. Nevertheless, it is necessary to change a practice that exposes patients to a known UTI risk factor and reach a consensus on indications for catheter insertion.

A comparison of augmentation cystoplasty before and after renal transplantation with the control group.

We compared two surgical methods of augmentation cystoplasty (AC), before and after renal transplantation, and the outcomes of both methods with transplant patients with normal bladder function. 1520 kidney transplantations were performed at Shahid Labbafinejad Center between March 1988 and February 2002 of which 36 cases was accompanied with AC. In 20 patients (group A) AC was performed before transplantation. This group consisted of 14 males and 6 females with a mean age of 26.1 (13-39) at the time of transplantation. Sixteen patients consisting of 11 males and 5 females (mean age 27.3, 12-44) underwent AC after transplantation. Eventually 40 transplant patients with normal bladder function were assigned in the control group including 18 males and 22 females with a mean age of 31.2 (11-55) (group C). Normal graft function was achieved in 16, 13, and 33 patients of groups A, B, and C respectively over the mean follow-up of 70, 59, and 76 months (p<0.7). Mean serum creatinine during the follow-up was 1.48+/-0.4, 1.7+/-1, and 1.4+/-0.55 for groups A, B, and C respectively. 9, 12, and 17 patients (26, 64, and 34 cases) with UTI requiring hospital admission were observed in the 3 groups respectively. The incident of UTI and the resultant hospitalization in group B was more than the one in group C (p<0.03), but it did not differ significantly from group A to group C. AC is a safe and effective method to improve the lower urinary system function and with the exception of increased risk of UTI following AC after transplantation (group B), there is no considerable difference in the complication rates between AC before and after renal transplantation. As a result, we can perform AC before or after kidney transplantation in patients with dysfunctional lower urinary tract system up to their specific conditions.

Doppler waveform of the ureteric jet in pregnancy

We have shown that the function of the bladder vesicoureteric junction (VUJ) can be studied by the Doppler waveform of the ureteric jet, and this reflects the active sphincteric mechanism of the VUJ. We wished to investigate if the hormonal changes of pregnancy cause any alteration of VUJ function. A total of 107 pregnant women and 375 nonpregnant women were recruited. Three scans, 20 and 32 weeks of gestational age and 3 months postpartum, were done. The occurrence of a monophasic waveform in the nonpregnant group was 1.9%. In the pregnancy group, this was 18.7%, 41.1% and 1.6% at 20, 32 weeks of gestational age and 3 months postpartum, respectively. The difference in occurrence of the monophasic waveforms was statistically significant (both p = 0.0005 at 20 and 32 weeks). This suggests an adverse hormonal effect on the vesicoureteric junction during pregnancy, and may be a factor in the increased risk of UTI in pregnancy.

Cohort Study on Circumcision of Newborn Boys and Subsequent Risk of Urinary-Tract Infection

Summary Background A decrease in risk of urinary-tract infection is one of the most commonly given reasons for circumcision of newborn boys. Previous studies have reported rates of UTI to be 10‐20 times higher in uncircumcised than in circumcised boys. This population-based cohort study followed neonates in Ontario, Canada, prospectively to study the relation between circumcision and subsequent UTI risk. Methods Eligible boys were born to residents of Ontario between April 1, 1993, and March 31, 1994. We used hospital discharge data to follow up boys until March 31, 1996. Findings Of 69 100 eligible boys, 30 105 (43·6%) were circumcised and 38 995 (56·4%) uncircumcised. 888 boys circumcised after the first month of life were excluded. 29 217 uncircumcised boys were matched to the remaining circumcised boys by date of birth. The 1-year probabilities of hospital admission for UTI were 1·88 per 1000 person-years of observation (83 cases up to end of follow-up) in the circumcised cohort and 7·02 per 1000 person-years (247 cases up to end of follow-up) in the uncircumcised cohort (p<0·0001). The estimated relative risk of admission for UTI by first-year follow-up indicated a significantly higher risk for uncircumcised boys than for circumcised boys (3·7 [2·8‐4·9]). 195 circumcisions would be needed to prevent one hospital admission for UTI in the first year of life.

Cohort study on circumcision of newborn boys and subsequent risk of urinary-tract infection

A decrease in risk of urinary-tract infection is one of the most commonly given reasons for circumcision of newborn boys. Previous studies have reported rates of UTI to be 10-20 times higher in uncircumcised than in circumcised boys. This population-based cohort study followed neonates in Ontario, Canada, prospectively to study the relation between circumcision and subsequent UTI risk. Eligible boys were born to residents of Ontario between April 1, 1993, and March 31, 1994. We used hospital discharge data to follow up boys until March 31, 1996. Of 69,100 eligible boys, 30,105 (43.6%) were circumcised and 38,995 (56.4%) uncircumcised. 888 boys circumcised after the first month of life were excluded. 29,217 uncircumcised boys were matched to the remaining circumcised boys by date of birth. The 1-year probabilities of hospital admission for UTI were 1.88 per 1000 person-years of observation (83 cases up to end of follow-up) in the circumcised cohort and 7.02 per 1000 person-years (247 cases up to end of follow-up) in the uncircumcised cohort (p<0.0001). The estimated relative risk of admission for UTI by first-year follow-up indicated a significantly higher risk for uncircumcised boys than for circumcised boys (3.7 [2.8-4.9]). 195 circumcisions would be needed to prevent one hospital admission for UTI in the first year of life. Although our findings support the notion that circumcision may protect boys from UTI, the magnitude of this effect may be less than previously estimated.

Use of Spermicide-Coated Condoms and Other Risk Factors for Urinary Tract Infection Caused by Staphylococcus Saprophyticus

tients. Exposure to spermicide-coated condoms during the previous month was associated with a higher risk of UTI (odds ratio [OR], 3.8; 95% confidence interval,1.410.3). The OR for exposure during the previous year ranged from 2.2 (95% confidence interval, 1.0-4.8) for less than once weekly to 6.05 (95% confidence interval, 2.2-16.6) for more than twice weekly. In multivariate analyses, younger age (OR, 0.97 per year), intercourse frequency (OR, 1.2 per weekly episode), prior UTI (OR, 3.3), and frequency of exposure to spermicide-coated condoms (OR, 8.4 for more than once weekly and 10.9 for more than twice weekly) were independent predictors of UTI. Among women exposed to spermicide-coated condoms, 74% of UTIs caused by S saprophyticus were attributable to this exposure. Conclusions: Spermicide-coated condoms were associated with an increased risk of UTI caused by S saprophyticus. Because sexual activity and spermicide exposure are important risk factors for UTI caused by both S saprophyticus and E coli, it is likely that they share a similar pathogenesis. Arch Intern Med. 1998;158:281-287

Cephadroxil promotes vaginal colonization with Escherichia coli.

The aim of this study was to examine whether a vaginal Escherichia coli colonization, mimicking the one seen in UTI-prone females, could be induced by local cephadroxil administration. When five adult cynomolgus monkeys were given a vaginal flush with a P-fimbriated E. coli strain, none became persistently colonized. When such colonization attempts were preceded by cephadroxil administration a persistent colonization occurred in 9/10 experiments. Cephadroxil also promoted a spread of fecal E. coli strains to the vagina. Reduction of the anaerobic vaginal flora can explain the breakdown of the colonization resistance. Clinical observations suggest that accumulation of E. coli around the urethral orifice increases the risk of UTI. Therefore antibiotics which promote such colonization may increase the risk for UTI in susceptible patients. From this point of view antibiotics such as cephadroxil may be less suitable for treatment of UTI-susceptible patients.

Prevention of Catheter-Associated Urinary Tract Infection with a Silver Oxide-Coated Urinary Catheter: Clinical and Microbiologic Correlates

In a prospective clinical trial involving 482 acutely hospitalized patients, the overall incidence of catheter-associated urinary tract infection (UTI; 10%) was similar in recipients of a silver oxide-coated urinary catheter (silver catheter) or a control silicone catheter. However, female sex and absence of antimicrobial use were independently associated with an increased risk of UTI. After stratification for these variables, the silver catheter reduced the incidence of UTI among women not receiving antimicrobial agents (19% for control catheter vs. 0 for silver catheter, P = .04; confidence interval for the difference in incidence, 0.4%-38%) but not in the other subgroups. Gram-positive UTI was associated with absence of antimicrobial use, the control catheter, and catheter care violations. Gram-negative and candidal UTIs were more common after 7 days of catheterization, and candidal UTI was associated with being female and antimicrobial use. These findings demonstrate that several clinical variables influenced the incidence and microbiology of catheter-associated UTI and that the silver catheter appeared to prevent UTI among women not receiving antimicrobials.

Antecedent factors in urinary tract infections among nursing home patients.

By a retrospective relative risk analysis for conditions associated with urinary tract infection over a four-year period in a defined teaching nursing home population (n = 97), we reached the following conclusions: (1) UTI was associated with cerebrovascular accident (relative risk 2.2, 95% confidence interval 1.4 to 3.2), decreased activities of daily living (relative risk 2.6 to 3.2, 95% confidence interval 1.4 to 4.7), decreased mental status (relative risk 2.2, 95% confidence interval 1.2 to 3.1), urinary catheterization (relative risk 2.5, 95% confidence interval 1.3 to 3.7), and antibiotic prophylaxis (relative risk 2.1, 95% confidence interval 1.2 to 3.0). (2) Risk of UTI from urinary catheterization and antibiotic prophylaxis was additive for these functionally impaired patients. (3) Renal insufficiency, diabetes, anemia, malnutrition, age, and incontinence (without catheterization) were not related to risk of UTI.