Simple Urinary Tract Infection Research Articles

Antibiotic Prescribing Practices on Hospital Discharge for Management of Urinary Tract Infections: A Single Center Study

Background: Appropriate antibiotic use has been described as one of the key strategies in tackling antibiotic resistance. Although the majority of antimicrobial therapy is completed following discharge, there lacks clear guidance in addressing antibiotic stewardship in the outpatient setting. Particularly, broader coverage as well as longer durations of therapy are often encountered following hospitalization. In our study we examine the various antibiotic prescribing practices on hospital discharge for management of urinary tract infections (UTI). Methods: We conducted a single-center, retrospective observational chart review of patients discharged from St. Francis Hospital and Medical Center in Hartford between May and July 2022. Medical records were reviewed for patients who were prescribed antibiotic therapy for management of UTI and met inclusion criteria. Variables of interest included type of UTI treated, antibiotic used, duration of antibiotics during and following hospitalization, fluoroquinolone use, as well reported adverse events. Total duration of therapy was defined as days on susceptible antimicrobials with appropriate source control. Results: A total of 84 patients met inclusion criteria. 44 received treatment for simple UTI (sUTI) and 40 for complicated UTI (cUTI). Figure 1 shows the various organisms identified on culture. The most common antimicrobials prescribed on discharge were cefpodoxime and ciprofloxacin [figure 2]. Quinolones were prescribed in 11.4% of sUTIs and 39.1% of cUTIs on hospital discharge. Of those, only one patient had no alternative to quinolone use due to drug allergies. The mean duration of therapy for treatment of sUTI was 6.4 days total (SD 2.40) with 3.9 days outpatient (SD 1.78). The mean duration of therapy for treatment of cUTI was 10.9 days total (SD 3.62) with 6.7 days outpatient (SD 2.99). Comparison of mean durations is shown in figure 3. In 49% of all cases (including both sUTI and cUTI) patients received greater than 7 days of antimicrobial therapy. Conclusion: There is increased evidence favoring shorter courses of antimicrobial therapy for management of both simple and complicated UTIs. A 7-day course has been shown as effective duration of therapy for cUTI with appropriate source control, regardless of presence of bacteremia. Results from our single center-study show both sUTI and cUTI are subject to unnecessarily prolonged durations of therapy on hospital discharge. In addition we noted a significant use of fluoroquinolones in cUTI treatment. We believe stewardship interventions at time of discharge may particularly benefit shorter courses of therapy for cUTI as well as reduced quinolone use.

A retrospective study of uropathogen and its antibiotic resistance among children with urinary tract infection from a single center in China

Urinary tract infection (UTI) is a well-known bacterial infection posing serious health problem in children. A retrospective study was conducted to explore the uropathogen and its antibiotic resistance in children with UTI. Data of urine culture and antimicrobial susceptibility test was collected. Consequently, 840 children were included. The overall culture-positive UTI was 458 (54.52 %) with Escherichia coli 166 (36.24 %), followed by Enterococcus faecalis 59 (12.88 %), Enterococcus faecium 70 (15.28 %) and others. They were highly resistant to the most commonly used antibiotics. In 694 children with complicated UTI, there were 8 children with fungal infection. Multiple drug resistance (MDR) was recorded in 315 (80.98 %). The overall proportion of Extended Spectrum β-Lactamase (ESβL) production was 25 (6.43 %). In 146 children with simple UTI, MDR were also detected in 47 (77.05 %). There were 6 (9.84 %) positive for ESβL production. Our study found that complicated UTI was relatively common. Escherichia coli was the most prevalent isolate, followed by Enterococcus faecium and Enterococcus faecalis. These organisms were highly resistant to the most commonly used antibiotics. Relatively high prevalence of MDR and low ESβL-producing organisms were observed.

How to define and assess the clinically significant causes of hematuria in childhood

Given the wide diversity of causes of hematuria, ranging from simple urinary tract infections with rapid recovery to severe glomerulonephritis with fast decline in kidney function, it is essential to recognize the underlying disease. The first objective of the assessment is to determine whether the cause of the hematuria is medically significant. The combination of hematuria with proteinuria, the presence of hypertension, or worsening kidney function can represent signs of progressive kidney disease. Differentiating the various causes of hematuria is often simple and obvious based on the clinical signs and gross appearance of the urine. However, in some instances, additional non-invasive investigations, such as ultrasound imaging, urinary red cell morphology, measurement of calcium and other solutes in the urine, evaluation of kidney function, and protein excretion, are needed to elucidate the nature of the hematuria. Taking a detailed family history can help in establishing the underlying cause in cases of familial hematuria. On the other hand, the decision to perform a kidney biopsy in children with asymptomatic hematuria remains a challenging issue for clinicians. Ultimately, the frequency of diagnosis of glomerular involvement causing hematuria may depend on the threshold for performing a kidney biopsy. The following review will focus on the diagnostics of hematuria, starting with difficulties regarding its definition, followed by various means to differentiate between urinary, glomerular, and other causes, and finally reviewing the most common diseases that, due to their frequency or their effect on kidney function, present a diagnostic challenge in everyday practice.

Empiric Guideline Therapy for Simple Urinary Tract Infection at Outpatient Clinics: A Prospective Observational Study

Background: Community-acquired urinary tract infection is a widespread problem encountered in the outpatient clinics of most hospitals. UTI has various clinical presentations; some are simple UTIs that can be managed with outpatient antibiotics. The current treatment of UTI is empirical, based on the limited and predictable spectrum of etiological microorganisms. Objectives: To collect information on the susceptibility tests of microorganisms in simple urinary tract infections (UTIs) and outline the best empiric antimicrobial prescribed for them. Methods: A total of 117 patients from 14 to 70 years of age (mean age = 43.61years, standard deviation = + 24.5) received the care of our surgical and urological outpatient clinics in Alnuman Teaching Hospital, Baghdad, Iraq, between March 1, 2019, and September 1, 2020. The patients who were showing symptoms of simple uncomplicated UTI and were prescribed empiric antibacterial treatment and requested for a sample of midstream urine for culture and sensitivity tests were enrolled in this prospective study. The susceptibility test for (ciprofloxacin, trimethoprim, gentamycin, and ceftriaxone) was performed using the Kirby–Bauer disc diffusion method. The data were input into SPSS 22.0 for statistical analysis. Pearson’s chi-squared test was used to compare parameters. The data have been presented as the number of variables (n) and percentages (%). Statistical significance was set at P < 0.05. Results: The frequencies of isolated uropathogens were as follows: E. coli, n = 65 (77.4%); Klebsiella spp., n = 9 (10.7%), Proteus spp., n = 3 (3.57%), Enterobacter spp., n = 3 (3.57%)., Staphylococcus spp., n = 2 (2.38%)., Pseudomonas spp., n = 1 (1.19%), and Candida spp., n = 1 (1.19%). The resistance rates of the most prevalent microorganisms were E. coli isolates to trimethoprim, ciprofloxacin, gentamycin, and ceftriaxone. The lower resistance rates to ceftriaxone in E. coli isolates (29.7%) was not clinically significant, with p < 0.05. Gentamycin showed significant sensitivity and resistance rates of 58.3% and 33.3% respectively, among the antimicrobials used (p < 0.05). The clinical effectiveness of empirical antimicrobial use in the treatment of simple UTIs showed no statistically significant correlation with P < 0.05. Conclusions: Trimethoprim and ciprofloxacin should not be used in empirical therapy for UTIs because of their increased resistance rates. A review of the local guidelines should be considered.

Nomogram for diagnosing acute pyelonephritis in pediatric urinary tract infection.

For risk stratification and individualized treatment for children with urinary tract infection (UTI), they must be assessed for the presence of acute pyelonephritis (APN). Our study aimed to combine variables that can predict APN and establish a nomogram for clinical use. In total, 111 children <5 years old hospitalized at Kaohsiung Veterans General Hospital for UTI were classified into APN and simple UTI groups based on a technetium-99m dimercaptosuccinic acid scan. Their demographic, laboratory test, and renal and urinary bladder sonography (RUBS) data were compared. Fever peak of >39°C, serum procalcitonin (PCT)≥0.52pg/mL, C-reactive protein (CRP)≥2.86mg/dL, and abnormal RUBS findings were independent variables for predicting APN in children. The nomogram established using the aforementioned variables had an area under the receiver operating characteristic curve (AUC) of 0.89, which was higher than those of PCT and CRP alone (0.776 and 0.774, respectively). The combination of four variables had the highest power in predicting APN in children with UTI. The established nomogram is practical for clinical use.

Study the effect of Canagliflozin in patients of type 2 diabetes mellitus inadequately controlled on maximum dose of three oral hypoglycemic agents

Metformin is the first- line pharmacotherapeutic agent implemented after life style modification to achieve the desired glycemic levels in patient with T2DM. [4] However, Metformin alone in many patients fail to maintain the desired glycemic levels in long term and they will require additional combination therapies.[5] Even though effective initially , agents included in the class of sulfonylurea has common side effects like hypoglycemia and weight gain.[6] It is also observed that drugs acting on pancreatic β cells will cause early exhaustion of β cells and the use of agents that utilize the insulin dependent pathways. After the analysis of data collected at the end of the study it was found that there was a significant reduction in fasting and post prandial blood sugar levels, HbA1c value and body weight. Along with these benefits few adverse effect including simple urinary tract infection, genital mycotic infection were recorded, these ADRs were mild and symptoms subsided after routine treatment.

Importance of Antimicrobial Stewardship in the Treatment of Urinary Tract Infection

Urinary tract infection (UTI) is a microbial contamination of the bladder and related organs. Study subjects were those who had no structural anomaly and no co-occurring diseases, such as diabetes, or were either immunocompromised or pregnant. Simple UTI is also defined as cystitis or inferior UTI. This study was a prospective, single center study conducted at a tertiary level clinic and its associated bacteriology laboratory. Patients whose urine tests were collected by the microbiology test center over a 6-month period were enrolled in the study. Culture and vulnerability results were obtained directly from the microbiology test center. Of the 1306 samples obtained, 888 (68%) were from females and 418 (32%) from males. This study identified the predominant UTI-causing microbes and the associated antimicrobial vulnerabilities. In males, Escherichia coli (36.8%) was the predominant microbe followed by Klebsiella pneumoniae 19.8%, Proteus spp. 17.4%, Staphylococcus aureus 10.0%, Pseudomonas aeruginosa 5.5%, Citrobacter spp. 5.0%, Staphylococcus saprophyticus 0.7%, Enterococcus faecalis 1.4%, and Acinetobacter spp. 0.7%. In females, E. coli (49.4%) was predominant, whereas Acinetobacter spp. (0.3%) was the least dominant. The considerable susceptibility of E. coli to meropenem (73.6%) and imipenem (73.5%) was similar to that reported in different investigations across India. In this study, the susceptibility of E. coli to piperacillin + tazobactam and ciprofloxacin was 42.7% and 14.3%, respectively. Stewardship of urinalysis and urine culture, especially among clinicians might be a successful upstream strategy for reducing inappropriate antimicrobial use for UTI. Thus, it is critical to routinely screen for resistance or susceptibility in samples of uropathogens, so the protocols for proper antibiotic treatment can be enhanced to incorporate antimicrobials with less resistance, supporting physicians in the appropriate treatment of UTIs resulting in insignificant remedial disappointments.

Clinical profile of children with primary vesicoureteric reflux and its association with renal parenchymal scarring

Context: Vesicoureteric reflux (VUR) has been implicated in renal injury before birth as well as in postnatal occurrence of urinary tract infection (UTI) and further renal damage. About 30–49% of children with primary VUR may develop renal scarring called reflux nephropathy. About 5–10% of children with reflux nephropathy may progress to chronic kidney disease in late childhood. Objectives: The objectives of the study were to study the clinical profile of children with primary VUR and to assess the relationship with grades of primary VUR and renal parenchymal scarring. Materials and Methods: Fifty children of age 1 month–5 years, diagnosed to have Primary VUR, were included in this prospective observational study. Detailed history was taken; examination was carried out as per the study protocol. Investigations included urine analysis, renal function tests, urine culture, renal ultrasonography, micturating cystourethrogram, and 99mTc dimercaptosuccinic acid (DMSA) scintigraphy. For those who had UTI, DMSA was carried out after a minimum period of 6 months after UTI episode. Results: Among the 50 children, 21 (42%) were male and 29 (58%) were female with male-to-female ratio of 0.72:1. Mean age at diagnosis was 9 months, ranging from 1 to 40 months. The number of children presented with UTI was 43 (86%), and 7 children (14%) were asymptomatic and were evaluated in view of abnormality in prenatal ultrasound scan. Unilateral VUR was found in 21 patients (42%), and 29 patients (58%) had bilateral VUR. Of all 79 refluxing units (21 unilateral plus 58 bilateral), 4% had VUR of Grade I severity, 30% of Grade II, 34% of Grade III, 28% of Grade IV, and 4% of Grade V severity. Renal parenchymal scarring on DMSA scan was detected in 42 (54%) of 79 refluxing units including 33% of Grade II, 55% of Grade III, 71% of Grade IV, and 100% of Grade V refluxing units. Prevalence of scarring in complicated, recurrent, and simple UTI was 100%, 93%, and 22%, respectively. Conclusion: Risk of renal scarring increased progressively with increasing severity of primary VUR. Complicated and recurrent UTI were found to be statistically significant risk factors for renal scarring. Renal scarring was also seen in absence of UTI in a small percentage of children with primary VUR.

Diagnostic Accuracy of Point-of-care Nitrite and Leukocyte Esterase Dipstick Test for the Screening of Pediatric Urinary Tract Infections.

Our study aimed to evaluate the diagnostic performance of point-of-care nitrite and leukocyte esterase (LE) dipsticks in the diagnosis of suspected urinary tract infection (UTI) in infants <6 months (young infants) versus older children. The secondary objectives were to study the dipstick efficacy in children with congenital anomalies of the kidney and urinary tract (CAKUT) versus those without CAKUT; in children with simple UTI versus complicated UTI; and to evaluate the clinico-microbiological profile of children presenting with UTI. In this prospective observational study, cases with suspected UTI were enrolled from pediatric emergency or outpatient departments. Urine was collected for performing the urine dipstick and culture. Descriptive data regarding CAKUT, age, gender, etc., were recorded in a predesigned pro forma. We screened 506 children with suspected UTI, of whom 221 had urine culture positive. Approximately 38.4% of the children with UTI had underlying CAKUT, while 7.6% had renal scars. The most common CAKUT was vesicoureteric reflux (VUR). About 12 patients (2.3%) were known to have CAKUT at the time of enrollment in the study. In infants <6 months, LE dipstick had sensitivity 92%, specificity 89.7%, positive predictive value (PPV) 86.7%, negative predictive value (NPV) 93.8%, likelihood ratio (LR) + 8.9, LR- 0.09. In infants <6 months, nitrite dipstick had sensitivity 38%, specificity 97%, PPV 90.4%, NPV 68%, LR+ 12.6 and LR-0.63. In the age group 6 months to 12 years, the efficacy was better for both dipsticks. In age group more than 6 months to 12 years, LE dipstick had sensitivity 96.4%, specificity 95.8%, PPV 94.8 %, NPV 97.2%, LR+ 22.9, LR- 0.04. In age group more than six months to 12 years, nitrite dipstick had sensitivity 94.7%, specificity 99.5%, PPV 99.3%, NPV 96%, LR+ 189.4, and LR-0.05.

P009: Quality improvement and implementation of urine culture follow up process

Background: The diagnosis of urinary tract infection (UTI) is made based on symptoms, urinalysis and urine culture. While simple urinary tract infections do not require routine culture, the Infectious Disease Society of America (IDSA) Guidelines state that complicated urinary tract infections should have urine cultures performed to determine which antibiotics are effective, as there is a higher risk of infection with resistant organisms. We hypothesized that the rate of urine cultures sent for complicated UTI is less than is recommended by the literature. Aim Statement: We aimed to implement a follow-up reporting system for Urinary Culture in patients diagnosed with complicated UTIs and raise our Urinary Culture rates in this population to 80% by June 2019. Measures &amp; Design: We performed a single-center chart review using Emergency Department (ED) charts of non-admitted patients. They were audited daily for two weeks to obtain a sample of patients who had a discharge diagnosis of urinary tract infection, pyelonephritis or cystitis. Charts capturing these diagnoses were assessed to see if a culture was clinically indicated and if it was ordered. Charts were screened for the presence of any of the following criteria indicating complicated UTI: known structural or functional abnormality of the urinary tract, genitourinary obstruction, pregnancy, immunosuppression, diabetes, indwelling or intermittent catheter use, fever, male patient, clinical pyelonephritis, antimicrobial failure, or transfer from a nursing home. Data was then compiled to determine culture rates in complicated and uncomplicated UTIs. This prevalence rate established the baseline performance in the ED which was used to inform the quality improvement project. Evaluation/Results: Over a two week period, 26 patients were discharged from the ED with a diagnosis of UTI, with 17 of these patients meeting criteria for complicated UTI. Only 6 of 17 complicated UTIs were sent for urine culture, therefore our pre-implementation culture rate was 35%. After initial data collection, a follow-up system was designed ensuring that urine culture and sensitivities results would be compiled and reviewed daily at Hamilton Health Sciences. This system was created with input from key stakeholders including department chiefs, core lab services, ED physicians and business clerks. A discrepancy form was created for documentation of culture result recognition and any required patient follow up ie. antibiotic change. In October 2019, the system had been implemented for a month, after which another chart review was completed. 27 cases were captured, 18 of which were complicated. The complicated culture rate had increased significantly from 35% to 72%. Discussion/Impact: In the ED, ordering of cultures for patients being discharged, regardless of type, is commonly associated with concern of result follow up, which may take up to 72 hours. This discrepancy system was implemented to ensure that all urine cultures ordered had appropriate follow up, thus supporting physicians in ordering cultures when indicated. The significant improvement in culture rate from 35% to 72% is balanced by one single culture of all 9 simple UTIs (11%). In PDSA cycle 2, we hope to increase rates to 90% by improving current challenges with the system.

The Proportion of Bifidobacterium and Escherichia coli in Colon of Children with Recurrent Urinary Tract Infection.

Recurrent urinary tract infection (UTI) in children is a well-known risk factor of chronic kidney disease. Periurethral area is normally inhabited by non-pathogenic flora, such as Bifidobacterium sp., and pathogenic flora from gastrointestinal tract, such as Escherichia coli (E. coli), which can cause UTI. Dysbiosis between pathogenic and non-pathogenic bacteria leads to infections, but studies regarding dysbiosis and recurrent UTI have not yet been documented. To estimate the proportional differences between gastrointestinal E. coli and Bifidobacterium sp. in children with recurrent UTI, a cross-sectional study was conducted in children from age six months to <18 years old diagnosed with recurrent UTI in Dr. Cipto Mangunkusumo Hospital. Healthy children matched in gender and age were recruited as control group. Stool samples were obtained from all the children in the two groups. Stool DNA was extracted using real-time polymerized chain reaction method to count E. coli and Bifidobacterium sp. proportion. Children with recurrent UTI had significantly higher proportion of E. coli compared to control group (10.97 vs. 4.74; P = 0.014) and lower proportion of Bifidobacterium sp. (6.54 vs. 9.33; P = 0.594). In children with recurrent UTI group, E. coli proportion was found higher than Bifidobacterium sp. although not statistically significant (10.97 vs. 6.54; P = 0.819). In healthy controls, Bifidobacterium sp. proportion was significantly higher than E. coli (4.74 vs. 9.33; P = 0.021). The total amount of E. coli (996,004 vs. 1,099,271; P = 0.798) and Bifidobacterium sp. (835,921 vs. 1,196,991; P = 0.711) were higher in secondary UTI compared to the simple UTI. Proportion of E. coli is higher in children with recurrent UTI than in healthy children. The proportion of E. coli is higher than Bifidobacterium sp in the colon of children with recurrent UTI.

SEPTICEMIA FROM URINARY TRACT INFECTION WITH NEGATIVE URINARY CULTURE: AEROCCOCUS URINAE IN AN OLDER ADULT

SESSION TITLE: Wednesday Medical Student/Resident Case Report Posters SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: 10/23/2019 09:45 AM - 10:45 AM INTRODUCTION: Aeroccocus urinae (A. urinae) is a gram-positive coccus that is known to cause simple urinary tract infections (UTI) in adults. However, it is exceedingly difficult to culture and is often misidentified for streptococci. In this report, we describe a case of an elderly male who presented with septic encephalopathy secondary to A. urinae bacteremia with a grossly positive urinalysis but negative urine cultures. CASE PRESENTATION: A 77-year-old man with a history of hypertension and diabetes who presented to the emergency department with agitation for two days. On presentation, he was oriented to name only and did not follow commands. Initial laboratory assessment revealed a white count of 12,600 U/L, lactate of 2.5 mmol/L and acute kidney injury (creatinine of 1.32 mg/dl). Urinalysis was grossly positive for UTI with turbidity, moderate leukocyte esterase, > 50 WBC, and numerous bacteria. Head CT was negative for acute stroke. Treatment with broad spectrum antibiotics (Vancomycin and Zosyn) was initiated for sepsis presumed to be secondary to UTI. The patient’s agitation worsened despite administration of multiple doses of Ativan and Haldol. The patient remained very agitated and violent so a precedex infusion was started and the patient was transferred to the ICU. Empiric antibiotics were continued as urine cultures remained normal. Eventually the patient’s initial blood cultures turned positive for A. urinae. Surveillance blood cultures obtained following initiation of antibiotic treatment remained negative, and the patient clinically improved over the next few days with continued antibiotic treatment. DISCUSSION: A. urinae is becomingly increasingly recognized as a pathogen causing urinary tract infection and septicemia due to improvements in laboratory techniques (spectrometry and gene sequencing) to isolate the organism. As such, it important to consider A. urinae as a potential pathogen in patients presenting with sepsis with a urinalysis concerning for infection even with negative urine cultures. Risk factors for the disease include male sex, advanced age (>70 years old), and underlying comorbidities, especially urological ones. Beyond complicated UTI and septicemia, Aeroccocus infection can have systemic implications including infective endocarditis, musculoskeletal abscesses and necrotizing urethritis. Fortunately, despite difficulty with isolating the organism, it remains sensitive to most antibiotics including penicillin, but fluroquinolone resistant strains have been reported. Our patient fit the clinical profile reported in the literature and responded well to vancomycin and cefepime. CONCLUSIONS: Aeroccocus urinae is common genitourinary pathogen that is widely underreported as a cause of septicemia given difficulties obtaining positive urine cultures. Intensivists should consider systemic infection with A. urinae in patients with positive urinalysis but negative urine cultures. Reference #1: Rasmussen, M. “Aeroccocus: an increasingly acknowledged human pathogen.” Clin Microbiol Infect. 2016 Jan;22(1):22-27. Reference #2: Rasmussen, M. “Aerococci and aerocccal infections.” J Infect. 2013 Jun;66(6):467-74. Reference #3: Senneby, E., Petersson, A.C., Rasmussen, M. “Clinical and microbiological features of bacteraemia with Aerococcus urinae.” Clin Microbiol Infect. 2012 Jun;18(6):546-50. DISCLOSURES: No relevant relationships by Matthew Durst, source=Web Response No relevant relationships by Peter Nauka, source=Web Response

Antimicrobial Susceptibility Patterns and Clinical Parameters in 208 Dogs with Positive Urine Cultures (2012-2014).

Urinary tract infections (UTI) occur commonly in dogs, and gram-negative enteric bacteria are the most prevalent pathogens. Clinical parameters, urinalysis, and urine culture and sensitivity results were retrieved from the medical records of 208 dogs with positive urine cultures over a 3 yr period at the Louisiana State University Veterinary Teaching Hospital. Several groups were defined including dogs presented for primary care versus referred cases; simple UTI, complicated UTI, and pyelonephritis; dogs pretreated with antimicrobials; and dogs having an indwelling catheter in place prior to sampling. Nearly 80% of dogs had complicated UTI. Of all dogs, 70% had no documented clinical signs of lower urinary tract disease (LUTD), with 68% of them showing hematuria and/or pyuria. Based on clinical signs or urinalysis, 19% of all dogs had no evidence of lower UTI. In dogs without LUTD signs the most common comorbidities were immunosuppressive treatment and severely restricted mobility (23%). Chronic recurring UTI were present in 19% of dogs with LUTD signs. Distribution of bacterial species was comparable with the existing literature and not significantly different between clinical subgroups. Isolates from dogs pretreated with antimicrobials showed decreased susceptibility to enrofloxacin. The prevalence of multidrug-resistant Escherichia coli and Staphylococcus spp. was moderate (29%).

Escherichia coli and Klebsiella pneumoniae Sensitivity/Resistance Pattern Towards Antimicrobial Agents in Primary and Simple Urinary Tract Infection Patients Visiting University Hospital of Jamia Hamdard New Delhi.

This study was carried out to record the sensitivity/resistance pattern of Escherichia coli and Klebsiella pneumoniae towards antimicrobial drugs prescribed to urinary tract infection (UTI) patients. A total of 68 bacteriologically proven simple UTI patients were included in the study, based on inclusion and exclusion criteria. Subjects demographics, antibiotics prescribed, sensitivity pattern of antibiotics towards the urinary pathogens were recorded in drug utilization and documentation form. The mean age of the patients was 29.32 years. The maximum number of patients fell under the age group 21-30 years. The maximum no of male and female patients belonged to the age group 21-30 years, 82.35% were females and 17.64% were males. E. coli found to be the most common uropathogens followed by Klebsiella pneumoniae. Nitrofurantoin was the most commonly prescribed drug followed by ciprofloxacin, levofloxacin and amoxicillin + clavulanic acid and amikacin. E. coli isolates showed high resistance for ampicillin followed by cotrimoxazole, norfloxacin, ciprofloxacin, gentamicin, tetracycline and ceftazidime and least resistance to amikacin, nitrofurantoin. Klebsiella pneumoniae isolates were highly resistant against ceftazidime, ampicilline, cotrimoxazole, nitrofurantoin, gentamicin, amoxicillin + sulbactam. Overall, the antibiotic against with high resistance found was ampicillin followed by cotrimoxazole, gentamicin, ceftazidime, norfloxacin, ciprofloxacin, tetracycline, levofloxacin, cefepime and least resistance to amikacin, netilmicin and nitrofurantoin. Majority of UTIs in this study were caused by E. coli followed by Klebsiella pneumoniae. The high resistance was found with ampicillin (75%). Nitrofurantoin was the most commonly prescribed drug followed by other flouroquinolones.

Effect of Cranberry on biofilm formation by P. mirabilis isolated from Patients Suffering from Urinary tract Infections

a total of (100) alkalineurine were obtained from a patient suffering from urinary tract infection from both sexes attended to Al- Hilla surgery Teaching Hospital during a period from September 2016 to December 2016 in Al-Hilla province. It was found that (23) P. mirabilis isolates were recovered where 14(60%) isolated obtained from patient with complicated urinary tract infection and 9 (39%) isolated obtained from patients with simple urinary tract infection from both sexes. Biofilm formation was also investigated using tissue culture plate, it was found the production of biofilm of P. mirabilis show that different potential capacity form biofilm, in complicated UTI, P. mirabilis is about 8(57%) which are strong former and the 6(42%) are mild former and 0(0%) in weak former of biofilm formation, So, in simple UTI P. mirabilis is about 0(0%) of P. mirabilis are strong former and the 5(55%) are mild former and 4(44%) in weak former of biofilm formation. Regard the effect of cranberry (5%) on biofilm formation was as wise studied; it was found that, the production biofilm of P. mirabilis show different potential capacity to form biofilm, the result of this study demonstrated that cranberry effectively reduced the viability of biofilm formation in complicated UTI. The biofilm formation was reduced as moderate to (28.57%), weak (71.42%) and no strong. So, in simple UTI the result was demonstrated that the biofilm production altered from (55%) to (0%).

Change in attitude towards antibiotic prescriptions among Icelandic general practitioners

Antibiotic use is a leading cause of antibiotic resistance and it is therefore important to reduce unnecessary prescribing in Iceland where antibiotic use is relatively high. The purpose of this study was to explore antibiotic prescribing practices among Icelandic physicians and compare the results with results of comparable studies from 1991 and 1995 conducted by the Directorate of Health, Iceland. A descriptive cross-sectional study was carried out among all general practitioners registered in Iceland in 1991 and 1995 and all physicians registered in March 2014. Data was collected with questionnaires regarding diagnosis and treatment of simple urinary tract infection, acute otitis media and pharyngitis. A multiple logistic regression analysis was performed and level of significance p≤0.05. Response rates were 85% and 93% in 1991 and 1995 but 31% in 2014. Proportion of physicians who consider themselves prescribing antibiotics more than 10 times per week was 36% in 1991, 32% in 1995 and 21% in 2014. Proportion of trimethoprim-sulfamethoxazole as first choice for simple urinary tract infection reduced from 43% and 45% to 8% in 2014. In 2014, general practitioners considered themselves 87% less likely to prescribe an antibiotic for acute otitis media than in 1991 (p<0.001). They also claimed to use rapid diagnostic tests in pharyngitis five times more often in 2014 than in 1991 (p<0.001). Antibiotic prescribing practices have changed significantly in the past two decades in Iceland becoming more in line with clinical guidelines. Improvements are still needed to further reduce inappropriate antibiotic use.

Persistence or Reinfection for Recurrent Urinary Tract Infections in Women: Cloudy Boundaries When it comes to Management?

Objective: To review current literature on the distinction between bacterial persistence or reinfection in recurrent urinary tract infections (RUTIs) in women and the resultant implications on evaluation and treatment. Methods: A systematic literature review focusing on studies of non-pregnant women with cystitis was conducted. Studies not in English, not in full-text, and relating to children, men, and pregnant women were excluded. Results: Between 1995 and 2012, 7 articles were identified from which the type of bacterial persistence/ reinfection status could be clearly established. While some study findings suggest that bacterial reinfection prevails in RUTI, others have concluded that bacterial persistence is quite frequent or dominates (33% to 82%). Recent data on evaluation and treatment also suggest a shift towards less need to distinguish between these two categories. Conclusions: While current RUTI management strategies hinge on delineating between bacterial persistence or reinfection, for women refractory to antibiotic therapy, one could argue that the boundary between the two groups may be irrelevant as optimal treatment may be the same regardless.Compared to simple urinary tract infections which are exceedingly common in women and relatively easy to treat, recurrent urinary tract infections (RUTIs) provoke treatment challenges, impact on quality of life, and substantial costs. Traditionally, RUTIs have been divided into two broad categories depending on urine culture findings: (1) Bacterial persistence refers to RUTIs caused by the same bacterial strain over and over again while (2) Bacterial reinfection implies a reinfection process from different bacterial strains. In this brief document, we reviewed the existing literature on the prevalence of these two forms of RUTI and briefly discussed the implications for their evaluation and treatment, while adding some newer information from our group and others. We will make the point that the boundaries between these 2 categories cansometimes be blurry and that their management may emerge as being similar in the end.

Emphysematous Pyelonephritis, Case Report and Review of the Literature

Background: Urinary tract infections in immunosuppressed patients, especially Diabetic ones with poor control, can progress to a severe necrotizing infection called emphysematous pyelonephritis (EP), a diagnosis that must be highly suspected in these cases for the presentation as a simple urinary tract infection with poor response to medical management. Delayed diagnosis increases the already high morbidity and mortality. Case: We present the case of a 47-year-old female admitted to emergency department for a 4 day disease characterized by fever, chills, adynamia, asthenia and right flank pain of moderate intensity. Past day she refers hematemesis in an occasion. She denied pathologic background. At physical examination with inflammatory response signs, right flank pain, positive Giordano sign and positive superior ureteral points, without signs of peritoneal irritation. Laboratories report white blood cells 13000/mm3, Hemoglobin 13.7 g/dL, Platelets 82000, Glucose 595 mg/dL, Cr 2 mg/dL. Gas Analysis report metabolic acidosis. Urianalysis report leucocytes >75μL, uncountable red blood cells, bacteries +++, nitrites+++ Glucose +++, proteins +, ketones ++. Pyelonephritis and Diabetes mellitus 2 of recent diagnosis was established. After two days of medical treatment she presented septic shock with acute renal failure AKIN II, hematological and hepatic disfunction. Mechanic ventilatory support and use of norepinephrine were adhere to therapy. This case was present in a rural hospital and the unique auxiliary imaging available was an abdomen X-ray that shows an air bubble in the right perirenal space. The diagnosis of emphysematous pyelonephritis was settled down and urgent right nephrectomy performed after platelet transfusion. The surgery was successful and without complications finding a right kidney of 9x6x4 centimeters with multiple parenchymal abscesses. After 11 days patient was discharged uneventfully. Conclusion: The diagnosis of EP must be highly suspected in Diabetes mellitus 2 patients with severe urinary tract infection and poor response to initial medical management. Medical management including parenteral antibiotics plus percutaneous catheter drainage or nephrectomy must be performed immediately according to the risk factors by the high morbidity and mortality associated with this disease.

A Case of Incidentally Detected Asymptomatic Emphysematous Pyelonephritis

Emphysematous pyelonephritis (EPN) is a severe gas-forming infection of the renal parenchyma and surrounding tissues. Patients with EPN commonly present with high fever, chills, and flank pain. These symptoms mimic a simple urinary tract infection, such that diagnosis is often delayed. Because of its life-threatening fulminant course, the early detection of EPN and its prompt treatment with intravenous antibiotics with or without percutaneous drainage are critical. Here we describe a case of a 63-year-old Korean female with diabetes mellitus who had no specific symptoms or signs of EPN. A chest computed tomography (CT) scan to assess a right pleural effusion incidentally detected an abnormal gas shadow in the renal parenchyma. An abdominal CT scan performed 5 days later showed increased gas within the kidney parenchyma, but the patient still had no symptoms of EPN. She was treated with intravenous antibiotics alone. A follow-up abdominal CT scan revealed the complete disappearance of the features of EPN. (Korean J Med 2015;89:567-570)

Evidence-based rules from family practice to inform family practice; the learning healthcare system case study on urinary tract infections.

BackgroundAnalysis of encounter data relevant to the diagnostic process sourced from routine electronic medical record (EMR) databases represents a classic example of the concept of a learning healthcare system (LHS). By collecting International Classification of Primary Care (ICPC) coded EMR data as part of the Transition Project from Dutch and Maltese databases (using the EMR TransHIS), data mining algorithms can empirically quantify the relationships of all presenting reasons for encounter (RfEs) and recorded diagnostic outcomes. We have specifically looked at new episodes of care (EoC) for two urinary system infections: simple urinary tract infection (UTI, ICPC code: U71) and pyelonephritis (ICPC code: U70).MethodsParticipating family doctors (FDs) recorded details of all their patient contacts in an EoC structure using the ICPC, including RfEs presented by the patient, and the FDs’ diagnostic labels. The relationships between RfEs and episode titles were studied using probabilistic and data mining methods as part of the TRANSFoRm project.ResultsThe Dutch data indicated that the presence of RfE’s “Cystitis/Urinary Tract Infection”, “Dysuria”, “Fear of UTI”, “Urinary frequency/urgency”, “Haematuria”, “Urine symptom/complaint, other” are all strong, reliable, predictors for the diagnosis “Cystitis/Urinary Tract Infection” . The Maltese data indicated that the presence of RfE’s “Dysuria”, “Urinary frequency/urgency”, “Haematuria” are all strong, reliable, predictors for the diagnosis “Cystitis/Urinary Tract Infection”.The Dutch data indicated that the presence of RfE’s “Flank/axilla symptom/complaint”, “Dysuria”, “Fever”, “Cystitis/Urinary Tract Infection”, “Abdominal pain/cramps general” are all strong, reliable, predictors for the diagnosis “Pyelonephritis” . The Maltese data set did not present any clinically and statistically significant predictors for pyelonephritis.ConclusionsWe describe clinically and statistically significant diagnostic associations observed between UTIs and pyelonephritis presenting as a new problem in family practice, and all associated RfEs, and demonstrate that the significant diagnostic cues obtained are consistent with the literature. We conclude that it is possible to generate clinically meaningful diagnostic evidence from electronic sources of patient data.Electronic supplementary materialThe online version of this article (doi:10.1186/s12875-015-0271-4) contains supplementary material, which is available to authorized users.