Significant Pyuria Research Articles

Bacteriological Profile of Urinary Tract Infection in Children of a Tertiary Care Hospital

Background: Urinary tract infection (UTI) is an important cause of morbidity and mortality in the paediatric age group. The spectrum of etiologic agents causing UTI and their antimicrobial resistance pattern has been continuously changing over the years. It varies among geographical locations, hospitals and also in different age groups.Objective: The aim of this study was to find out the causative agents of UTI and their antibiotic sensitivity pattern in paediatric patients in CMH, Dhaka.Methodology: This is an observational cross sectional study. A total of 180 children aged 0 months to 15 years attending pediatric outpatient department or admitted in Department of Paediatrics CMH, Dhaka with suspected UTI were subjected for urine routine and microscopic examination between June 2015 to May 2016. Those having pyuria (n=120) were then sent for urine culture and sensitivity to the laboratory of Armed Forces Institute of Pathology (AFIP). Patients having significant growth of organism were enrolled as cases of confirmed UTI. After enrollment, relevant information such as age, sex, sociodemographic profile was obtained and recorded in case record form.Result: In the present study, urine routine microscopy was done in all 180 cases of suspected UTI. Among all urine analysis 67% had significant pyuria (n=120). Of the 120 cases with pyuria, 58 cases were having culture positive accounting 48.3% of the total sample studied. Occurrence of urinary tract infections was highest in the age group below 5 year (62.5%). UTI was more prevalent in girls (63.3%) with male to female ratio 1:1.7. E. coli was the commonest isolate (62.1%) followed by Enterococcus (19.2%) and Klebsiella (10.2%). E. coli was found to be most sensitive to Ciprofloxacin, Nitrofurantoin, Amikacin, and Levofloxacin in descending order. There was a generally high level of resistance of isolates to Cotrimoxazole, Amoxycillin, Aminoglycosides, Azythromycin and the Cephalosporins like Cefuroxime, Ceftazidime, Cefixime and Ceftriaxone compared to Ciprofloxacin, Nitrofurantoin and Levofloxacin.Conclusion: Based on our findings, Ciprofloxacin, Levofloxacin and Nitrofurantoin are appropriate for initial empirical therapy for UTI among Bangladeshi children.Bangladesh J Child Health 2017; VOL 41 (2) :77-83

Prevalence of urinary tract infections in febrile children less than five years of age: a chart review

Background: In children less than five years of age, fever is the most common reason to visit emergency/outpatient pediatric departments. Quite often, the child receives antibiotics empirically, without adequate evaluation for urinary tract infection. The objectives of this study were to evaluate the prevalence of urinary tract infection (UTI) in febrile children, less than 59 months of age.Methods: Records of 370 children between 1 to 59 months of age, attending the department of paediatrics with febrile illness were reviewed. Data related to age, gender, socioeconomic status, nutritional status, clinical diagnosis, abdominal ultrasound, urinary microscopy and urine culture were analysed.Results: Records of 370 children were evaluated, among them, 240/370 (64.86%) children were below two years, and 130/370 (35.13%) were above two years. 165/370 (44.6%) were males, and 205/370 (55.4%) were females. The overall occurrence of urinary tract infection as defined by significant pyuria was 48/370 (12.9%) in children less than five years of age. The prevalence of UTI in children less than one year of age was 26/370 (7%), whereas it was 15/370 (4 %) in less than two years of age and 7/370 (1.8%) between two to five years. Among pyuric patients, 13/48 (27%) had a urine culture positive reports. The positive urine culture was seen in 6/13 (46%) of children with pus cells> 5/HPF and remaining 7/13 (54%) in children with pus cells >10/HPF. E. coli was the predominantly [9/13 (69%)] seen organism in urine cultures.Conclusions: In present study, the overall occurrence of UTI in children less than five years was 13%. Only 3.5% of children had culture-positive UTI. 46% of positive cultures were found in children having urine pus cells > five /HPF in the centrifuged sample, it is recommendable that children with pyuria should be evaluated thoroughly to initiate prompt treatment and have a successful outcome.

ROLE OF URINARY TRACT INFECTION IN DEVELOPMENT OF NEONATAL PATHOLOGICAL UNCONJUGATED HYPERBILIRUBINEMIA

Introduction: American Academy of Pediatrics recommends investigating for urinary tract infection (UTI) in neonates with conjugated hyperbilirubinemia, but UTI may be associated with unconjugated hyperbilirubinemia also. Objective: The objective of this study was to evaluate the frequency of UTI in initial 4 weeks of life in pathological unconjugated hyperbilirubinemia and to study the effect of treatment of UTI on the course of hyperbilirubinemia in these neonates. Methods: This hospital-based prospective cohort study included 100 consecutive neonates with a gestational age more than or equal to 35 weeks and <42 weeks with unconjugated hyperbilirubinemia in pathological range. Babies were treated with phototherapy (and exchange transfusion), and neonates with UTI were treated with antibiotics also. The primary outcome was the frequency of UTI, confirmed by a positive urine culture and secondary outcomes included positive leukocyte esterase (LE) and nitrite reactions, significant pyuria, and rate of fall of bilirubin levels. Results: Seven neonates had a positive urine culture growth (UTI group) while remaining 93 babies constituted non-UTI group. In the UTI group, six and five babies had positive LE and nitrite reactions, respectively, and four babies had significant pyuria also. Exchange transfusion was done in 23 neonates in the non-UTI group. The median (range) duration of phototherapy in the remaining 70 neonates in the non-UTI group was 39 (15

Clinical and microbiological profile of urinary tract infection in children less than five years of age

Background: Urinary tract infection (UTI) is a common bacterial illness of pediatric age group. UTIs, especially in young children, have non-specific signs and symptoms that can be undetected or misdiagnosed. Delaying diagnosis and treatment of UTIs may result in long-term renal complications. Objectives: The objectives were to study the clinical presentation of UTI, common uropathogens, and antimicrobial sensitivity pattern among children &lt;5 years of age. Materials and Methods: This is a hospital based prospective descriptive study which included 100 children &lt;5 years of age who presented with UTI over a period of 1 year. Detailed history,clinical examination, and laboratory investigations including urine analysis and culture were documented. Results: Out of the 100 children below 5 years who presented with UTI, 32% were below 1 year age. Male to female ratio in our study was 2.8:1. The most common presenting symptom was fever followed by crying during micturition. 92% of the cases had significant pyuria. Escherichia coli is the most common pathogen isolated (68%), followed by Klebsiella and Enterococcus. 62% had abnormal ultrasonography findings, most common being hydronephrosis (36%). Conclusions: The presentation of pediatric UTIs varies widely with ageand sex. Knowledge of the varied presentation of UTI, its risk factors and local antimicrobial sensitivity patterns are of great significance in preventing future complications in children.

Asymptomatic bacteriuria in pregnant women attending Boo-Ali Hospital Tehran Iran: Urine analysis vs. urine culture.

BackgroundAsymptomatic bacteriuria is one of the common problems in pregnancy. Asymptomatic bacteriuria is associated with pyelonephritis, preterm labor and low birth weight infants. The physiological and anatomical changes in pregnancy facilitate urinary tract infection (UTI) during pregnancy. Several tests are available for diagnosis of asymptomatic bacteriuria. The urine culture is a gold standard diagnostic test for asymptomatic bacteriuria but it is expensive and time-consuming. Screening methods may be useful in detecting high-risk pregnant women for asymptomatic bacteriuria.ObjectiveThe aim of the present study was to compare urine analysis as a rapid screening test to urine culture in diagnosis of asymptomatic bacteriuria.MethodsA total of 123 pregnant women attending the obstetrics clinic of Boo-Ali hospital in Tehran, Iran from March 2013 to September 2014 were included in the present diagnostic cross-sectional study. One hundred twenty three mid-stream urine samples were inoculated into cultures and were processed by dipstick (nitrite test and leucocyte esterase test) and microscopic pus cell count. The sensitivity, specificity, positive predictive value and negative predictive value of nitrite test, leucocyte esterase test and microscopic pus cell count were compared with urine culture in diagnosis of asymptomatic bacteriuria by using SPSS version 19.ResultsOf 123 urine samples, significant asymptomatic bacteriuria (≥104 cfu/Ml) was detected in 8 (6.5%) subjects. The sensitivity and specificity of nitrite test were 37% and 100% respectively. The sensitivity of pus cell count alone and leucocyte esterase test alone were 100% but the specificity of them were 64% and 65% respectively. We found high negative predictive value by Pus cell count and the leucocyte esterase test (100%) and low positive predictive value by them (16% and 17% respectively).ConclusionUrine culture is the most useful test for diagnosis of asymptomatic bacteriuria. None of our screening tests had a sensitivity and specificity of 100%, whereas we can only refer the pregnant women with positive leucocyte esterase test and significant pyuria to the urine culture.

Association between pyuria and uropathogen in suspected urinary tract infection

Background: Urinary tract infections (UTI) are one of the most common infectious diseases diagnosed in outpatients as well as in hospitalized patients, and can lead to significant mortality. Several rapid methods have been developed in diagnosing urinary tract infections such as microscopic examination, chemical tests, and automated systems. Thus, in this study we aimed at determining pyuria in suspected UTI patients and their association with uropathogen. Materials and Methods: A total of 379 clean catch mid-stream urine samples were collected in sterile containers. Manual microscopy is used to determine pyuria. All the urine samples inoculated on routine bacteriological media. Results: Out of 379 urine samples, 181 yielded significant bacterial growth. Patients belonged to age group 21-30 were more commonly had significant growth followed by 11-20 years age group. Escherichia coli was the most common organism isolated. Majority of urine specimens which showed plenty of pus cells per high power field yielded significant growth. Escherichia coli was most commonly associated with pyuria. Conclusion: As the number of pus cells in urine increases, the chance of yielding significant bacterial growth is also high. Overall, significant pyuria was observed among specimens yielded Gram negative bacilli than Gram positive cocci. Among Gram negative bacilli, Escherichia coli was most commonly accompanied with pyuria.A

An appraisal on antibiotic susceptibility of common bacterial pathogens in urinary tract infections at a Nigerian Tertiary Health Center

Background: Urinary tract infections (UTIs) with concomitant rise in antibiotic resistance among uropathogens remained a major health problem. A periodic appraisal of the microbial agents responsible for UTIs with their antimicrobial susceptibility is, therefore, fundamental for a fitted empirical antimicrobial intervention. This study determined the range of bacterial species in patients with suspected UTI and their antibiotic susceptibility pattern at a tertiary care center in Nigeria. Patients and Methods: This was a retrospective review of urine samples subjected to microscopy, culture, and sensitivity from patients with suspected UTI in 2015. Bacterial isolates were identified by biochemical profiling. The antibiotics susceptibility of the culture-positive isolates was achieved by disk diffusion method as recommended in the Clinical Laboratory Standard Institute guidelines. Results: There were 1,096 urine samples subjected to microscopy, culture, and sensitivity during the study period; 1,001 met the inclusion criteria. Urine microscopy yielded significant pyuria in 23.2% and sterile pyuria in 8%. Urine culture was positive in 43% of the specimens and yielded Escherichia coli in 28%, Staphylococcus aureus was seen in 6.1%, and Klebsiella in 4.8%. Out of the positive cultures, 35.3% specimens have significant pyuria. The most sensitive antibiotics were Streptomycin, Ciprofloxacin, and Gentamycin. Resistance was predominantly to Nalidixic acid, Ceftriaxone, and Ampicillin. Conclusion: Periodic appraisal of the uropathogens and evaluation of their sensitivity is a needed guide in empirical antibiotic interventions. In this appraisal, E. coli was the commonest agents in patients with UTI. Most of the microbes were sensitive to Aminoglycoside and Ciprofloxacin but often resistant to Nalidixic acid and Ceftriaxone.

Frequency of urinary tract infection in febrile children of one to five years of age

Introduction: Fever is the most common reason for children 1-5 years of age to visit Emergency / out patient departments. Little attention has been focused on the identification of urinary tract infections in febrile children, despite recent information that suggests a high prevalence of urinary tract infections and significant associated morbidity in these patients. This study is undertaken to determine the prevalence of urinary tract infection in febrile children one year to five years of age and to evaluate various diagnostic methods for a case of Urinary tract infection. Method: Febrile children (rectal ≥38.3˚C or auxiliary temperature ≥37.8˚C) of 1 to 5 years of age were studied over a period of 12 months February 2015 to January 2016 at our tertiary care centre. History and relevant investigations were done. Result: The study included 200 children. The overall prevalence rate of urinary tract infection in the present study was 5.5% with prevalence in children 1-2 years of age 2%. 13.5% of cases showed significant pyuria. Among pyuric patients 40.74% were culture positive with a M:F of 1.2:6. USG done in significant pyuric cases revealed renal involvement /anomaly in 6 cases. Conclusion: Clinicians should consider obtaining a urine specimen as part of their diagnostic evaluation as urinary tract infection is a possibility in febrile children. Pyuria of ≥ 5 pus cells /HPF in centrifuged sample should be considered as significant pyuria and further evaluation should be done promptly to initiate treatment and to prevent morbidity and long term sequalae.

Can absence of pyuria exclude urinary tract infection in febrile infants? About 2011 AAP guidelines on UTI.

The aim of this study was to describe clinical and laboratory characteristics of urinary tract infection (UTI) without significant pyuria in young children aged 2-24 months. The subjects consisted of infants and young children with febrile UTI treated at Pusan National University Children's Hospital, Korea. Group A included 283 patients with definite UTI who fulfilled the revised American Academy of Pediatrics diagnostic criteria, and group B included 19 patients with presumed UTI who had significant culture of uropathogens without pyuria, bacteriuria or other focus of infection. Duration of fever before hospital visit in group B was significantly shorter than in group A (17.7 ± 14.0 vs 34.5 ± 30.7 h). Most patients in group B (17/19, 89.5%) came to the hospital within 24 h of onset of fever. Acute scintigraphic lesions were found in 47.8% of patients in group A and 50% in group B. Underlying urological abnormalities such as vesicoureteral reflux and obstructive uropathy were found in 24.5% of patients in group A and in 33.3% of patients in group B (P = 0.74). Clinicians cannot exclude UTI on the absence of pyuria in young children aged 2-24 months.

Environmental Factors in Renal Disease: The Contribution of Urinary Tract Infections in Nigerian Renal Disease Burden-Research

Background: Asymptomatic and mild nature of urinary tract infections (UTIs) make them underrated, overlooked but dangerous, because they are prelude to most renal diseases. Like asymptomatic UTIs, some renal diseases are symptomless until they have reached advanced stage, making their victims easily vulnerable to complications before actual diagnosis of renal disease may be made. This study was aimed at surveying the environmental factors responsible for the renal disease burden of Nigeria with a particular focus on the contributions of UTIs. Method: Urine samples from renal disease patients of the University of Nigeria teaching hospital (UNTH), Enugu, Nigeria were analyzed for bacteriuria using standard microbiological procedures. Results: An overall incidence of 28% bacteriuria was obtained, based on the criterion of significant bacteriuria (> 105 colonies/ml). While fungal yeasts, Candida albicans contributed 30%, various bacterial species jointly accounted for 70% of the entire microbial agents responsible for UTIs among the subjects. Subsequent Gram’s, microscopy and biochemical characterization tests revealed seven bacterial species viz Escherichia coli (29%), Klebsiella spp (22%), Proteus mirabilis (14%), Pseudomonas aeruginosa (7%), Streptococcus faecalis (7%), Staphylococcus aureus (7%) and Staphylococcus epidermidis (14%). Gender distribution of the isolates showed that S. aureus was isolated from the males while E. coli, Proteus mirabilis, Streptococcus faecalis and Pseudomonas aeruginosa from the females; Klebsiella spp was isolated from the males (33%) and females (67%) respectively, while S. epidermidis was isolated equally (50%) from both sexes. Adoption of leucocytes’ presence in urine as part of diagnostic criteria revealed significant bacteriuria with significant pyuria (21%), significant pyuria without significant bacteriuria (52%), and significant bacteriuria without significant pyuria (7%), no significant bacteriuria without significant pyuria (20%). Also, urinalyses gave proteinuria (84%), haematuria (45%) and glycosuria (6%). Conclusions: The study revealed an overall incidence of 28% bacteriuria. Though UTIs by sundry bacterial organisms and fungal Candida albicans made reckonable contributions to the renal disease load of UNTH, Enugu, additional evidence from urinalyses revealing proteinuria, glycosuria and haematuria, etc., suggest that apart from the UTIs, diabetes mellitus and/or urinary schistosomiasis (possibly accounting for the haematuria) are part of the diseases complex defined by yet-to-be identified factors (possibly including chemical entities) in our environment that determine the burden and patterns of renal diseases profile of Nigeria. Further search is thus warranted.

Frequency Survey of Asymptomatic Bacteriuria in Pregnant Women Attending Boo-Ali Hospital, Tehran

Background: During pregnancy, asymptomatic bacteriuria is associated with different complications such as pyelonephritis and preterm birth. Pregnancy changes pave the way for the growth and multiplication of pathogenic factors. This study was aimed at exploring the frequency of asymptomatic bacteriuria among pregnant women who attended Boo–Ali Hospital, a teaching center of Islamic Azad University in Tehran. Materials and Methods: This cross-sectional study was performed on 123 pregnant women without urinary symptoms who attended Boo–Ali Hospital from March 2013 to September 2014. Demographic information of the patients including age, gestational age at the time of experiment and parity were recorded. An amount of middle part of urine (20cc) was collected in an appropriate sterile container. Urine samples were examined for WBC, RBC and bacteria. Other parts of the samples were cultivated for urine culture (U/C). Results: Two (1.6%) women had significant bacteriuria (≥105/ml). Pyuria, bacteriuria and hematuria were seen in 49(39.8), 7 (5.6%) and 8 (6.5%) women, respectively. There was a significant association between positive U/C and pyuria (P=0.003). However, positive U/C showed no significance association between bacteriuria and hematuria (P&gt;0.05). Conclusion: Regarding the low frequency of asymptomatic bacteriuria (less than 2%) in the investigated population, the administration of U/C does not seem logical for all pregnant women. Hence, U/C is recommended for those with significant pyuria in their urinalyses. [GMJ.2015;4(4):159-63]

Clinical profile and antibiotics sensitivity in childhood urinary tract infection at Dhulikhel Hospital.

Urinary Tract Infection implies presence of actively multiplying organisms in the urinary tract. Although it is infrequently associated with mortality, it is still a significant cause of morbidity. Early diagnosis is critical to preserve renal function of growing kidney. Our purpose was to determine the clinical, microbiologic profile and antibiotic sensitivity of such infections in pediatric Urinary Tract Infection (UTI) patients at Dhulikhel Hospital. A hospital based prospective descriptive study of 135 children from 2 months to 16 years, with clinical diagnosis of urinary tract infection who visited the pediatric department of Dhulikhel Hospital over the period of 15 months were enrolled in the study. All patients underwent routine urine analysis and culture. Children with recurrent UTI underwent micturating cystourethrogram (MCUG). Children with recurrent UTI of more than two years and with feature of pyelonephritis underwent USG abdomen as well. Complications and response of the treatment was observed in all cases of UTI. All data were entered in Epidata and data analysis was done using spss 16 version. Among 135 children, 32.5% were male and 67.4% were female. Fever was the most common presenting symptom in 74.80% of patients followed by dysuria in 54.1%. Among these children 95.6% had significant pyuria and 45% had culture positive infection. Children who showed positive for bacteriuria, Escherichia coli (78.7%) was the most common organism and are more than 80% sensitive to Amikacin, Gentamicin, Ceftriaxone, Ofloxacin, Nalidixic acid, Imipenem and Vancomycin. Co-trimoxazole was the most common drug used for treatment with a mean drug respond time of (mean+/-S.D) of 2.21+/-.78 days. 2+/-. Children who had recurrent UTI were more prone to develop culture positive UTI (p=0.0001). Urinary Tract Infection in female was almost twice more common than in male. Cotrimoxazole was the most common drug used for treatment, sensitivity of this drug was less than 50% for all organisms.

Detection of Pyuria versus Bacteriuria in Suspected Patients of Urinary Tract Infection

Urinary tract infection (UTI) is one of the most important causes of mortality and morbidity in the world affecting all age groups across the life span. The aim of this study is to determine incidence of bacteriuria and its relation with pyuria in suspected urinary tract infection. This crosssectional-descriptive-analytical study was conducted in microbiology section of Kathmandu Hospital, Tripureshwor from May to August 2011. During this period, 412 midstream urine samples collected were investigated by microscopic examination of centrifuged urine sediment and conventional semi-quantitative culture technique. Out of 412 MSU samples, 120 (29.13%) were culture positive. The remaining 22 (18.33%) samples showed low count significant bacteriuria (i.e 104-105 CFU/ml) and 98(81.67%) showed significant bacteriuria (i.e. ≥ 105 CFU/ml). Among 88 urine samples with significant pyuria, only 74 (84.09%) showed culture positive. Out of 324 urine samples without significant pyuria, 46 (14.19%) urine samples showed culture positive result. Significant pyuria was found to have sensitivity of 61.67%, specificity of 95.21% and the test has 84.09% positive predictive value in detecting bacteriuria. Pyuria and bacteriuria may not always correlate in the suspected case of UTI.DOI: http://dx.doi.org/10.3126/njst.v15i1.12029Nepal Journal of Science and TechnologyVol. 15, No.1 (2014) 129-132

Pyuria as a diagnostic test for urinary tract infection in children with sickle cell anaemia in Zaria, Nigeria

Objective: This study aimed at determining the significance of pyuria as a screening test for UTI in children with sickle cell anaemia (SCA).Methods: Two hundred and seventy-two children with SCA, aged 6 months to 15 years, were studied out of which 185 (68.0%) were in stable state and 87 (32.0%) were in crises. Their urine was assessed for microscopy culture and sensitivity. Significant pyuria and bacteriuria was determined using standard methods. Results: Significant bacteriuria was detected in 22 (8.1%) of the 272 subjects with SCA. The prevalence of significant bacteriuria was higher among those in crisis (18/87; 20.7%) than in those in steady state (4/185; 2.2%) and the difference was statistically significant (χ2 = 27.323, p = 0.001). Of the 22 SCA subjects with confirmed UTI, 19 (86.4%) had significant pyuria with a sensitivity of 86.4%, specificity of 68.8%, and positive predictive value of 19.6%. The most common bacterial isolates were Escherichia coli 11 (50.0%) while the least isolated were Salmonella typhi 1 (4.6%).Conclusion: This study indicates that pyuria as a screening test for UTI is not very specific but very sensitive necessitating a more test to be done for diagnosis of UTI.Keywords: Sickle cell anaemia, bacteriuria, pyuria, children

Do patients who complain of lower urinary tract symptoms frequently have clinically significant pyuria?

There is still controversy about whether post-void residual (PVR) urine volume affects the onset of urinary tract infection (UTI). In addition, although male patients with lower urinary tract symptoms (LUTS) might potentially have PVR, the association between LUTS and UTI or asymptomatic pyuria with or without bacteriuria remains unclear. We studied the frequency of asymptomatic pyuria, with and without bacteriuria, in patients with LUTS without a previous history of urinary tract manipulation at the first visit and their sequential courses. This retrospective study was done by reviewing medical charts. A total of 453 male patients who complained of LUTS and visited our outpatient clinic in 2008 were included in this study. The frequency of pyuria, with or without bacteriuria, in this study at the first visit was 4.9%. The median PVR volumes at the initial examination were 79 ml in the 22 patients with pyuria and 22 ml in the 431 patients without pyuria. The difference of the PVR volume between the patients with pyuria and those without pyuria was statistically significant (p = 0.0095). Twelve patients were treated with alpha-blockers without antimicrobial chemotherapy and pyuria disappeared in 5 (41.7%) of them. However, the decrease in the rate of PVR was not significantly different between the patients with persisting pyuria and those without pyuria. A not negligible number of patients with LUTS had pyuria at the first visit; however, there was no febrile UTI in their clinical course even if they received no urological manipulation.

Prevalence Of Urinary Tract Infection In Febrile Children Less Than Five Years Of Age

The aim of the present study was to diagnose the urinary tract infection in febrile children and to assess the validity of microscopic urine analysis and urine culture in the diagnosis of UTI. It is a prospective study conducted in a tertiary care hospital. 370 children were included in the study, data related to age, sex, nutritional status, socioeconomic status and predisposing risk factors like urethral instrumentation, bowel habits etc, were noted. A thorough physical examination with relevant investigations was carried out in all patients. Routine blood counts, urine analysis was done and those showing pus cells &gt;5 per HPF in centrifuged urine sample were taken as study group and urine culture sensitivity was done in them. A total of 370 febrile children were included in the study, out of 370 patients in study 165 were males and 205 were females with M: F ratio 1:1.2 and majority of them i.e.64.8% were &lt;2years. In our study out of 370 children 48 children showed significant pyuria(12.9%) of pyuric cases 26% showed significant bacterial growth making an overall prevalence of 3.5%.Among culture positive UTI'S 76% were &lt;2years of age with a overall prevalence of 4.1% in children &lt;2years and 7%in children &lt;1year.

MP27-12 IMPACT OF PRE-OPERATIVE PYURIA ON OUTCOMES OF URETEROSCOPY FOR URINARY STONES

You have accessJournal of UrologyStone Disease: Therapy III1 Apr 2014MP27-12 IMPACT OF PRE-OPERATIVE PYURIA ON OUTCOMES OF URETEROSCOPY FOR URINARY STONES Koji Mitsuzuka, Osamu Nakano, Go Anan, and Makoto Nakano Koji MitsuzukaKoji Mitsuzuka More articles by this author , Osamu NakanoOsamu Nakano More articles by this author , Go AnanGo Anan More articles by this author , and Makoto NakanoMakoto Nakano More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2014.02.375AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES We examined the impact of pre-operative pyuria on the results of ureteroscopy for urinary stones including stone-free rate or complications. METHODS Data from 156 patients undergoing ureteroscopy for renal or ureteral stones between 2011 and 2013 was retrospectively reviewed. Patients were classified according to whether they had pyuria or not preoperatively. The definition of pyuria was 10 or more white blood cells per high power field. Antibiotics before utereroscopy was used for all patients with febrile urinary tract infection or symptomatic pyuria, while was not always used for patients with asymptomatic pyuria. RESULTS Of the total 156 patients, 98 (62.8%) were male, 71 (45.5%) had stone history. Median age was 57 (17-89) year-old and median stone size was 16 mm (5-110). Sixty-two (39.7%) had multiple stones. The location of stones was 91 cases in ureter (58.3%), 26 cases in kidney (16.7%) and 25 cases in both kidney and ureter (16.0%). Seventy patients (44.9%) had pyuria preoperatively, and patients with pyuria were likely to be old (P=0.009) and obese (P=0.037), and have diabetes mellitus (P=0.003), renal stones (P=0.035) and large stone size (P<0.001) compared with patients without pyuria. Median operative time between patients without and with pyuria was 60 (20-200) and 103 (19-220) minutes, respectively (P=0.001). Stone free rate (< 2mm) between patients without and with pyuria was 94.2% and 75.7% (P=0.003). Post-operative high fever (>38 degrees Celsius) was seen in 5.8% of patients without pyuria, while in 21.4% of patients with pyuria (P=0.004). Severity of pyuria was associated with frequency of post-operative high fever, and urosepsis occured in two patients who had significant pyuria (50 or more white blood cells per high power field). In multivariate analysis, pyuria was an independent predicting factor for post-operative high fever (HR 5.68, 95% CI 1.71-10.98, P=0.004), while not for residual stones or prolonged operative time. CONCLUSIONS Pyuria at the time of ureteroscopy for urinary stones was associated with presence of diabetes mellitus, large stone size, prolonged operative time and residual stones. Moreover, pyuria was an independent predicting factor for post-operative high fever which could cause urosepsis. © 2014FiguresReferencesRelatedDetails Volume 191Issue 4SApril 2014Page: e278-e279 Advertisement Copyright & Permissions© 2014MetricsAuthor Information Koji Mitsuzuka More articles by this author Osamu Nakano More articles by this author Go Anan More articles by this author Makoto Nakano More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Urinary Tract Infection and Drug Susceptibility Pattern in Patients of a Medical College Hospital in Bangladesh

Background: Urinary tract infection (UTI) is a common and frequently encountered serious morbidity that afflicts the tool not only to all segments of human population but also results in increasing antibiotic resistance due to persistence and mismanagement of the ailment. The present study aimed to ascertain the current situation of antimicrobial resistance of urinary tract infection. Objectives: To find out pyuria by direct microscopy, isolation and identification of the organisms by culture and to know the susceptibility pattern of organisms causing urinary tract infection. Materials and Methods: A total of 180 midstream urine samples were subjected to aerobic bacteriologic culture in the department of Microbiology, Cox’s Bazar Medical College and 250-bedded Sadar Hospital, Cox’s Bazar during the period of March to October 2012. Specimens were collected from hospitalized and outdoor patients of different age and sex groups. All specimens were examined by routine microscopy to find out significant pyuria (&gt;5 pus cells/HPF). Strict aseptic precautions were taken all through the culture system. Results: Out of 180 specimens, 101 (56.11%) culture yielded significant growth of single organism and 79 (43.89%) yielded no growth. The isolated organisms were E. coli 74.26%, Klebsiella species 12.87%, Enterococci 4.95%, Staphylococcus saprophyticus 3.96%, Pseudomonas species 1.98% and Proteus species 1.98%. The highest sensitivity was shown by imipenem (100%) followed by ceftriaxone (65%), azithromycin (65%), ciprofloxacin (60%) and less sensitive to amoxycillin, cotrimoxazole, cephradine and nalidixic acid ranging 15–30%. Conclusion: The findings of the present study recommends that UTI should be treated by selective antibiotics obtained from culture and sensitivity test to minimize increasing trend of drug resistance. DOI: http://dx.doi.org/10.3329/jemc.v4i1.18064 J Enam Med Col 2014; 4(1): 21-25

Bacterial uropathogens isolates and antibiograms in children under 5 years of age.

Background:Childhood urinary infections are among the most common febrile illnesses occurring during this period with varying susceptibility to antibiotic.Aim:The aim of this study was to identify uropathogens responsible to for urinarytract infection (UTIs) in children less than 5 years of age, and determine the antibiograms of the isolates to commonly used antibiotics.Patients and methods:Hundred and four children (2 months - 5 years old) seen at the Gadarif Teaching Hospital from January 2012 and December 2013 were evaluated. A urine specimen was obtained by a plastic bag with an adhesive backing around an opening or by direct voiding into sterile container. Urine was examined microscopically and those with significant pyuria and bacteruria were further cultured and microorganisms were identified and tested for antimicrobial susceptibility.Results:Out of 304 children suffering from UTIs; 145(47.7%) had significant pyuria of them; 54(17.8 %) had positive bacterial growth. The frequency of sex and residency were almost the same. E. coli (42.6%) was the most common uropathogen, sensitive to ciprofloxacin (91.3%), followed by Pseudomonas aeruginosa (29.6%) sensitive to Ciprofloxacin (75%)and Norofloxacin (68.8%), Klebsiellapneumoniae (18.5%) sensitive to Ciprofloxacin and Norofloxacin and Nalidixic acid (90%) and Proteus mirabilis sensitive to Ciprofloxacin and Norofloxacin (90%), Amoxicillin / clavulanic acid (Augmentin(80%).Conclusion:The most common uropathogens were E. coli, Pseudomonas aeruginosa,Klebsiellapneumoniae, and Proteus mirabilis. Ciprofloxacin is the recommended initial empirical therapy while awaiting the culture and sensitivity results.

Early Post-Transplant Urinary Tract Infections; Impact on Graft and Patient Survival

Introduction: Sepsis is the commonest cause of morbidity and mortality following solid organ transplantation. Urinary Tract Infections (UTI) including graft pyelonephritis is the commonest cause for sepsis related graft and patient loss following renal transplantation. Significant pyuria (pus cells >10 per high power field in a standard urinanalysis) is a common finding in End Stage Renal Disease (ESRD). The causative factors include low urine volumes, bladder stasis, underlying renal parenchymal disease, chronic haemodialysis, and latent or overt UTI. Its presence often confounds the decision and timing of renal transplantation. In this study we looked at the possible association of pre-operative pyuria with the incidence of post-transplant UTI, other identifiable risk factors for post-transplant UTI and their overall impact on graft and patient survival. Methodology: Three hundred and four (304) consecutive kidney transplants performed by the Colombo University Transplant Unit, Sri Lanka between January 2007 and March 2011 were prospectively analysed. All were living donor transplants and the mean follow up was 12(2-36) months. All those with significant pyuria were investigated extensively prior to transplantation to exclude a treatable cause (UTI, stones, tuberculosis etc.). If a treatable cause was identified, it was treated completely before proceeding to transplantation. All transplant ureters were routinely stented and routine standardized antibiotic prophylaxis was given perioperatively. Results: A total of 62 (62/304, 20%) early UTI were encountered in this cohort which included 15(5%) cases of graft pyelonephritis. In a multivariate analysis, diabetes mellitus in the recipient (p=0.9), female gender (p=0.7), acute rejection in the first month (p=0.3) and pre-operative pyuria (p=0.6) were not significantly associated with early UTI. 49/62 (79%) of the UTIs were successfully treated with complete resolution while 6 (10%) were associated with Primary Graft Failure (PGF) and 5 (8%) with sepsis related deaths. One with PGF also died during follow up while 1 was re-transplanted after complete resolution of the UTI. Four patients with PGF remain on haemodialysis awaiting re-transplantation. Conclusion: The incidence of post-transplant UTI is high in our experience. Likewise, the incidence of significant pyuria in the local population awaiting renal transplantation in this resource limited setting has also been shown to be high. However, this study showed that once a treatable cause was excluded or treated, pre-operative pyuria did not have any significant correlation with post-transplant UTI. The quest for minimizing UTI and thereby the related graft and patient loss continues.