Suspicion Of Urinary Tract Infection Research Articles

Validity of urine dipstick test to assess eradication of urinary tract infection in persons with spinal cord injury

To prospectively study the predictive value (PV) of urine nitrite (NIT) dipstick testing against urine cultures during antibiotic treatment for urinary tract infection (UTI), and other situations, in patients with spinal cord injury (SCI). Inpatients with SCI on intermittent catheterisation (IC) or a Foley indwelling catheter (FC) were included. Urine specimens were collected in patients without symptoms (routine), with symptoms of UTI (suspicion), and on day 4 of a 5-day antibiotic treatment (ATB+3). A total of 157urine samples were collected in 61patients: 34 were on IC (95samples) and 27 on FC (62samples). The prevalence of asymptomatic bacteriuria in the urine cultures was 89% in routine (70 samples). At ATB+3, microbiological cure was found in 27/30specimens (IC group) and 2/6 (FC group). In the routine condition, the specificity and positive PV of the NIT tests was 1.00 and sensitivity 0.63. The negative PV was low in both groups. In suspicion of UTI, the sensitivity was between 0.69 and 0.55, the positive PV was 1.00 and the negative PV 0.00 for both groups. At ATB+3, the negative PV and sensitivity was 1.00, specificity 0.85 and positive PV 0.43 in the IC group, and in the FC group, specificity was 1.00, negative PV 0.33 and sensitivity 0.00. In the SCI population on intermittent or indwelling catheters with high prevalence of bacteriuria, dipstick testing helped assess the eradication of germs during antibiotic treatment, but showed no value in the decision making process for UTI. 3.

Urinary tract infection in children: clinical aspects and utility of urine dipstick test

Background: Urinary tract infection (UTI) is a common genitourinary disease in children and accounts for significant morbidity. To prevent the potentially dangerous sequel, early detection of UTI in childhood is essential. This depends entirely on strong clinical suspicion and urine culture report. Recently, advances in investigations are taking place to diagnose UTI rapidly. Urine dipstick is one such bedside method to diagnose UTI. This study aims at studying the clinical features of UTI and evaluating sensitivity and specificity of urine dipstick in diagnosing UTI.Methods: This study was conducted at a tertiary care hospital in Vadodara from January 2013 to June 2014, on 60 children admitted with clinical suspicion of urinary tract infection. Along with study of clinical features, results of urine dipstick tests (Nitrite and Leukocyte esterase), urine microscopy and urine culture were compared. Accuracy of urine dipstick tests was assessed statistically by evaluating sensitivity, specificity, positive and negative predictive values considering urine culture as a gold standard.Results: Fever was found to be the most common presenting features (53%) in all the patients studied. The sensitivity of urine microscopy, Nitrite test and Leucocyte esterase test was 63.5%, 50% and 61% and specificity was 25%, 31% and 25% respectively. Combination of Nitrite and Leucocyte Esterase test had an improved sensitivity (68%).Conclusions: Urinary tract infection can present with variety of non-specific signs and symptoms especially in younger age. Dipstick test using Leucocyte Esterase and Nitrite together is better than urine microscopic examination alone. Urine culture as a confirmatory test still remains gold standard.

Urine Contamination in Nontoilet-trained and Uncircumcised Boys

To assess any differences between the initial and midstream urine samples from nontoilet-trained, uncircumcised boys. Contamination during urine collection makes the diagnosis of urinary tract infections (UTIs) difficult in nontoilet-trained children, especially in uncircumcised boys. Whether the contamination comes mainly from the initial stream or the contact between urine and perineal skin is not known in this population. A prospective diagnostic study between early and midstream urine samples was conducted on asymptomatic patients with no suspicion of UTI. The clean void method was performed in nontoilet-trained boys under general anesthesia. The exclusion criteria were circumcision, older than 3 years of age, recent antibiotics treatment, and recent UTI. Urinalysis and urine culture were performed, allowing a comparison between early and midstream urine samples. Forty-four patients were enrolled in the study, and 31 satisfactory samples were obtained. A higher contamination rate was found in the early stream (n = 16; 51%) than in the midstream (n = 5; 16%) (P < .01). The positive culture from the early stream sample was statistically associated with a lower age (P = .02). The contamination rate of the first stream is 3-fold higher than for the midstream when collecting urine for urine culture. The clean void method in nontoilet-trained, uncircumcised boys provides low-quality urine samples for both early and midstream urine samples. The benefit of catching midstream urine samples for the diagnosis of UTI in this population is even more important when the children are young.

Childhood urinary tract infection in primary care: a prospective observational study of prevalence, diagnosis, treatment, and recovery.

The prevalence of targeted and serendipitous treatment for, and associated recovery from, urinary tract infection (UTI) in pre-school children is unknown. To determine the frequency and suspicion of UTI in children who are acutely ill, along with details of antibiotic prescribing, its appropriateness, and whether that appropriateness impacted on symptom improvement and recovery. Prospective observational cohort study in primary care sites in urban and rural areas in England and Wales. Systematic urine sampling from children aged <5 years presenting in primary care with acute illness with culture in NHS laboratories. Of 6079 children's urine samples, 339 (5.6%) met laboratory criteria for UTI and 162 (47.9%) were prescribed antibiotics at the initial consultation. In total, 576/7101 (8.1%) children were suspected of having a UTI prior to urine sampling, including 107 of the 338 with a UTI (clinician sensitivity 31.7%). Children with a laboratory-diagnosed UTI were more likely to be prescribed antibiotics when UTI was clinically suspected than when it was not (86.0% versus 30.3%, P<0.001). Of 231 children with unsuspected UTI, 70 (30.3%) received serendipitous antibiotics (that is, antibiotics prescribed for a different reason). Overall, 176 (52.1%) children with confirmed UTI did not receive any initial antibiotic. Organism sensitivity to the prescribed antibiotic was higher when UTI was suspected than when treated serendipitously (77.1% versus 26.0%; P<0.001). Children with UTI prescribed appropriate antibiotics at the initial consultation improved a little sooner than those with a UTI who were not prescribed appropriate antibiotics initially (3.5 days versus 4.0 days; P = 0.005). Over half of children with UTI on culture were not prescribed antibiotics at first presentation. Serendipitous UTI treatment was relatively common, but often inappropriate to the organism's sensitivity. Methods for improved targeting of antibiotic treatment in children who are acutely unwell are urgently needed.

G425(P) Reliability of urine dipstick and microscopy for diagnosing urinary tract infections (UTIs) in children – an audit

AimTo determine the reliability of urine dipstick and microscopy in diagnosing UTIs in children.MethodsUrine samples were obtained from children admitted with a suspicion of UTI over a period of 30...

Empirical Antimicrobial Prescriptions in Patients withClostridium difficileInfection at Hospital Admission and Impact on Clinical Outcome

To determine, among patients with Clostridium difficile infection (CDI) at hospital admission, the impact of concurrent use of systemic, non-CDI-related antimicrobials on clinical outcomes and the risk factors associated with unnecessary antimicrobial prescribing. Retrospective cohort study. University-affiliated community hospital. We reviewed computerized medical records for all patients with CDI at hospital admission during a 24-month period (January 1, 2008, through December 31, 2009). Colectomy, discharge to hospice, and in-hospital mortality were considered to be adverse outcomes. Antimicrobial use was considered unnecessary in the absence of physical signs and laboratory or radiological findings suggestive of an infection other than CDI or in the absence of antimicrobial activity against the organism(s) recovered from clinical cultures. Among the 94 patients with CDI at hospital admission, 62% received at least one non-CDI-related antimicrobial during their hospitalization for CDI. Severe complicated CDI (odds ratio [OR], 7.1 [95% confidence interval {CI}, 1.8-28.5]; [Formula: see text]), duration of non-CDI-related antimicrobial exposure (OR, 1.2 [95% CI, 1.03-1.36]; [Formula: see text]), and age (OR, 1.1 [95% CI, 1.0-1.1]; [Formula: see text]) were independent risk factors for adverse clinical outcomes. One-third of the patients received unnecessary antimicrobial therapy. Sepsis at hospital admission (OR, 5.3 [95% CI, 1.8-15.8]; [Formula: see text]) and clinical suspicion of urinary tract infection (OR, 9.7 [95% CI, 2.9-32.3]; [Formula: see text]) were independently associated with unnecessary antimicrobial prescriptions. Empirical use of non-CDI-related antimicrobials was common. Prolonged exposure to non-CDI-related antimicrobials was associated with adverse clinical outcomes, including increased in-hospital mortality. Minimizing non-CDI-related antimicrobial exposure in patients with CDI seems warranted.

Empiric antibiotics for an elevated PSA: A randomized, prospective multi-institutional trial.

32 Background: The impact of an empiric course of antibiotics for a newly elevated PSA in an asymptomatic male is poorly understood. Methods: Men of any age with a PSA &gt; 2.5 ng/ml and normal digital rectal examination undergoing their first prostate biopsy were recruited from six medical centers. Patients with previous biopsy, prostate cancer, urinary tract infection (UTI) or prostatitis within the prior year, antibiotic use within one month, 5−alpha reductase inhibitor use, allergy to fluoroquinolones or clinical suspicion of UTI were excluded. Men were randomized to two weeks of ciprofloxacin 500 mg twice daily or no antibiotic. A PSA was obtained 21−45 days following randomization and immediately prior to prostate biopsy. All patients received institution−specific prophylactic peri−procedural antibiotics. Primary endpoint was change in PSA between baseline and on the day of biopsy. The trial was closed early following an interim analysis and decision rule for futility and early stopping. Results: Complete data was available on 77 men with a mean age of 60.6 (IQR: 53.8 – 66.7). In the control group (no antibiotic; n=39), mean baseline and pre−biopsy PSA were 6.5 and 6.9 ng/ml, respectively (p=0.8). In men receiving antibiotic (n=38), mean baseline and pre−biopsy (post−antibiotic) PSA were 7.6 and 8.5 ng/ml, respectively (p=0.7). Prostate cancer was detected in 36 (47%) men. Detection rates did not significantly differ between individuals with an increasing PSA or decreasing PSA between the two measurements. Conclusions: Empiric use of antibiotics for an elevated PSA in an asymptomatic patient is not of clinical benefit.

Evaluation of the Value of Modified Nitrite Test in Early Detection of Urinary Tract Infection in Children

Objective – The study was conducted in order to evaluate the value of the modified nitrite test in the diagnosis of urinary tract infection (UTI) in children. Patients and methods – The study included 300 children of both sexes, aged 1 month to 14 years who were examined due to suspicion of UTI at the Department of Paediatrics, University Clinical Center Tuzla in the period from August 1, 2006 to August 1, 2007. In relation to the age, the patients were divided into two age groups: from 1 month to 2.0 years and from 2.1 years to 14 years. These groups will further be referred to as the younger and older groups. A cross-sectional study was used to analyze the biochemical examination of urine using test strips (nitrite and modified nitrite test) and the urine culture results. Results – The described modification of the nitrite test significantly improved its sensitivity (88%) (p=0.001), NPV (96%) (p<0.0001), LR (-) (0.1) and it is more reliable than the nitrite test to exclude the existence of a UTI. The harmony between nitrite and modified nitrite (k=0.66, 95% CI: 0.56, 0.76, p<0.001) and between the modified nitrite test and the urine culture is good (k=0.79, 95% CI: 0.72, 0.87, p <0.001). Through reliability analysis of the modified nitrite test according to the age groups, we found that in the younger age group, after the modification of the nitrite test, its sensitivity was improved (83%), although not significantly (p=0.153), the NPV (94%) (p<0.0001) and LR (-) (0.2) was also improved. The harmony between the nitrite and modified nitrite test was moderate (k=0.59, 95% CI: 0.43, 0.75; p<0.001), and between the modified nitrite test and urine culture it was good (k=0.79, 95% CI: 0.61, 0.87; p<0.001). In the older age group, after the modification its sensitivity was significantly improved (93%) (p=0.001), NPV (98%) (p<0.0001); LR (-) (0.1). The harmony between the nitrite and the modified nitrite test was good (k=0.72, 95% CI: 0.60, 0.85; p<0.001), and between the modified nitrite test and the urine culture it was very good (k=0.84, 95% CI: 0.75, 0.94; p<0.001). Conclusion – The value of the modified nitrite test is characterized by the improved reliability of the nitrite test to exclude the existence of a UTI, especially in older children, which is important for clinical practice.

Intrapelvic pin migration after periacetabular reconstruction and arthroplasty of the hip in metastatic pelvic disease—a case report

In January 1997, a 62-year-old man was diagnosed with a hypernephroma of the right kidney and bilat-eral pulmonary metastases. He underwent a right nephrectomy as initial surgery. Histology showed a 16-mm granular cell renal carcinoma of the lower part of the right kidney. He received chemotherapy with α-interferon for the following 11 months. In November 1999, CT showed a 4-cm osteolytic lesion from the right posterior inferior iliac spine to the roof of the acetabulum. The medial and lat-eral bony borders were partially destroyed and the lesion was therefore classified as class III accord-ing to Harrington (1981).The patient underwent local radiation therapy in December 1999, and a second course of chemo-therapy with vinblastine. Immune modulation ther-apy with α-interferon showed a partial remission of the pulmonary metastases. In addition, he received intravenous treatment with bisphosphonates. In February 2000, the patient sustained a patho-logical fracture of the right iliac wing with medial and cranial dislocation of the entire acetabulum.A second course of radiation therapy was given in August 2000. In April 2001, the patient presented with an advanced right periacetabular fracture (Figure 1). A periacetabular reconstruction and a total hip arthroplasty was performed. A reinforcement cage (Burch-Schneider, Protek, Switzerland) was com-bined with a cemented standard stem with a 28-mm metal ball head and cemented polyethylene inlay. After reduction of the fracture, structural continu-ity was achieved and reinforced with 3 Steinmann pins using the compound osteosynthesis tech-nique, i.e. the pins were entirely covered with bone cement, which filled the gap. 1 pin was inserted from the superior iliac crest to the cranial part of the acetabulum, and 2 pins through the center of the acetabulum. One of these pins was unthreaded (Figure 2). The pins were cut off flush with the iliac crest.The patient quickly regained pain-free walking using 2 crutches. At routine follow-up (6 months), he was satisfied with the functional result (Figure 3).In November 2001, the patient suffered an epi-sode of transient hematuria and was treated under the suspicion of urinary tract infection. An abdomi-nal sonography showed mild hepatic steatosis but no other abnormalities. 9 months after surgery, a routine pelvic radiograph (Figure 4) showed migration of one of the Steinmann pins. A CT scan was performed, which showed the dislocation of the pin into the pelvic cavity very close to the blad-der, the anterior side of the rectum and the prostate (Figure 5). There was no sign of any penetration of the neighbouring organs. The dislocated pin was removed under general anesthesia by a modified ilio-inguinal approach without difficulty. The his-tological findings showed no signs of local tumor

Appendicitis in Pregnancy: A report from Zaria, Nigeria.

In a retrospective review of 21 pregnant patients who had appendicectomy for suspicion of appendicitis, 18 had histological confirmation while 2 had lymphoid hyperplasia and 1 was normal, giving a negative appendicectomy rate of 14.3%. The incidence of confirmed appendicitis in pregnancy was 1:1,236 deliveries. Of the 18 patients, 5 had complications of the disease (mass 3, perforation 2), while 13 were uncomplicated. The age range was 16-40 years (mean 26.8 years). The disease was more common in patients with high parity of 3 and above and one-half were in the second trimester. The common features were right iliac fossa and right flank pain and tenderness; nausea, anorexia and fever were less frequent. There was an average delay of 2.7 days between admission and surgical consult, due mostly to a suspicion of urinary tract infection. Three patients, including the 2 with perforation developed superficial wound infection. There was no maternal or perinatal mortality. Hospital stay was 7-14 days (mean 10.2 days). Negative appendicectomy was not associated with any complications (Nig J Surg Res 2000; 2:52-56) KEY WORDS : Appendicitis, Pregnancy

Hypertension, pyelonephritis and renal failure: Clinical interrelations

We have tried to illustrate some of the relations between hypertension, pyelonephritis and renal failure, and have emphasized both that the hypertensive patient probably is more susceptible to pyelonephritis and that infection, when he contracts it, may be an important factor in the deterioration of his renal function and in the aggravation of his hypertension. Although the exact nature of the linkages and the timing of what comes first remain open to question, there would seem to be little doubt that in the hypertensive patient pyelonephritis should be vigorously treated in the hope of preventing further progression of the vascular disease, despite the fact that in some instances the impact of the antibiotics may not be obvious. Nor do we believe that it is safe to ignore low bacterial counts, particularly when obtained by catheter technic, but rather we should err on the side of “overtreatment”whenever there is suspicion of urinary tract infection in the severely hypertensive patient.